GP Sceptics

‘Carrots & Sticks’ by Kat Ritchie

Doctors try to ‘sell’ behaviour change to patients, who are often reluctant to ‘buy’ the message. What tricks can we learn from the modern experts at selling?

Justin and Liz bite the bitter bullet and enter the strange world of marketing.

We grill Dr Ninya Maubach, whose former life involved a PhD in marketing, but who has now seen the light and is studying medicine at ANU. That’s a powerful combo when it comes to teaching doctors how to sell a message.

Our starting point is a paper ‘Carrots, Sticks and Promises’, and it turns out that most of our attempts at behaviour change involve the least effective selling method: “I promise that if you stop this pleasurable thing today (e.g. smoking, lying on your couch), you will reap rewards in the future.”

That message is pretty easy to trump (are we still allowed to use that word?), and plenty of full-time tobacco and food industry marketers know just how to trump it.

Turns out the ‘stages of change’ model  we all learned (precontemplation, contemplation)may not be so useful after all.

References:

Carrots, Sticks and Promises: a conceptual framework for the management of public health and social issue behaviors  Rothschild M, Journal of Marketing 1999

Stages of change model (Transtheoretical model) Wikipedia entry, accessed 2017

No Advertising Please campaign Coleman J et al, accessed 2017

One minute’s exercise – how much does it prolong your life? Inala Primary Care Journal Club, 2014

Thanks to Ninya Maubach (med student), Kat Ritchie (GP and artist)

by Kat Ritchie

Just when you thought GP Sceptics put the E in evidence-based medicine, we pull the rug from underneath your trusting feet.

Western Australian GP Casey Parker, of Broome Docs fame, joins our twosome to become the ‘third nerd’ – a role which fits him like a cardigan and a new pair of glasses.

Casey delves into EBM’s dark recesses, where p-hackers subvert the concept of ‘significance’, and RCTs answer all the questions no one bothered asking.

Justin discusses a hot-off-the-press systematic review revealing the over-optimism of doctors.

And Liz? Liz invites us all aboard the EBM gravy train.

Bonus nerd points for any listener who comments below correctly describing when affect is a noun and effect is a verb.

This podcast is dedicated to the fond memory of the late Prof Gavin Mooney, editor of Evidence-based medicine in its place.

Thanks to Dr Kat Ritchie for her brilliant artwork.

References:

Dr Casey Parker hosts Broome Docs – full of educational podcasts for GPs!

Casey describes his site as, “a single place for all you time-poor doctors to come and get quality education, clinical tips and interact with one another without having to search all over the internet. As a busy GP I am more than happy to stand on the shoulders of academic giants, I find the good ones have a great way of keeping the complex simple – just the way I like it.”

Why Most Published Research Findings Are False Ioannidis J, PLOS Medicine 2005

Evidence-based medicine has been hijacked: a report to David Sackett Ioannidis J, Journal of Clinical Epidemiology, 2016

Angiotensin–Neprilysin Inhibition versus Enalapril in Heart Failure  NEJM, 2014

Alltrials; All Trials Registered | All Results Reported

Clinicians’ expectations of the benefits and harms of treatments, screening, and tests: A systematic review Hoffmann T, Del Mar C, JAMA Internal Medicine 2017

By Kat Ritchie

Liz shines when discussing her pet PhD topic – managing obesity in general practice. Nicely timed for Christmas.

Which medications safely make us thinner, now amphetamines and tobacco have lost favour? And, if media images keep depicting Headless Fatties*, how can GPs raise the topic without adding to the stigma?

Justin reveals that one of Australia’s biggest GP education companies is boasting it can change our prescribing habits at will – for a hefty fee.

Build your own promotional campaign with Liz’s Magic Marketing, and discover the superpower Justin wishes he possessed but his family knows he doesn’t.

*Not our term – the podcast and link below place this memorable idiom in context. We wouldn’t insult Santa.

References:

Effects on Weight Reduction and Safety of Short-Term Phentermine Administration in Korean Obese People Yonsei Medical Journal, 2006

Headless fatties by Charlotte Cooper, 2007

Treating obesity seriously: when recommendations for lifestyle change confront biological adaptations Lancet, 2015. [But note authors’ multiple conflicts of interest]

No Advertising Please campaign 2014

They wouldn’t do that, would they? The Medical Republic, 30 Nov 2016

World Obesity image bank Free usage for non-profit purposes

Ten thousand miles away…Australia’s closest lyme-carrying tick

To coincide with today’s Senate inquiry on how to catch Lyme Disease in Australia (short version – you can’t), Justin and Liz interview infectious disease expert Prof Frank Bowden, from Australian National University.

Frank swats aside a series of claims by Australian lyme disease proponents, but sounds stumped when Justin asks whether sentinel chickens or sentinel ticks are better at keeping watch.

The conversation takes a few twists, lurching from false positive US lab results to unrelated matters such as whether having sex before the game enhances or detracts from sports performance. You’ll have to listen to find out the answer.*

*Or you could always cheat and read the reference below 

References:

Infectious: A doctor’s eye-opening insights into contagious diseases

Frank Bowden’s book, published 2016, including the chapter “Lyme is the new black”

Sexual Activity before Sports Competition: A Systematic Review

Frontiers in physiology June 2016

By Neko Richiko