Channeling Aristotle

As we consider the commercial success of high cost and clinically questionable proton beam machines, femtosecond lasers, and robotic surgery, we have come to suspect that these result in great measure from direct-to-consumer marketing by doctors during vulnerable periods of people's lives.  I recently learned of an article in Surgical Innovation that confirms these suspicions, but helps us understand the details a bit better. Oddly, the article also hearkens back to advice from Aristotle.

It's called "The impact of marketing language on patient preference for robot-assisted surgery."  Here's the abstract:

Robot-assisted surgery is gaining momentum as a new trend in minimally invasive surgery. With limited evidence supporting its use in place of the far less expensive conventional laparoscopic surgery, it has been suggested that marketing pressure is partly responsible for its widespread adoption.

The impact of phrases that promote the novelty of robot-assisted surgery on patient decision making has not been investigated. We conducted a discrete choice experiment to elicit preference of partial colectomy technique for a hypothetical diagnosis of colon cancer. A convenience sample of 38 participants in an ambulatory general surgery clinic consented to participate. Each participant made 2 treatment decisions between robot-assisted surgery and conventional laparoscopic surgery, with robot-assisted surgery described as "innovative" and "state-of-the-art" in one of the decisions (marketing frame), and by a disclosure of the uncertainty of available evidence in the other (evidence-based frame).

The magnitude of the framing effect was large with 12 of 38 subjects (31.6%, P = .005) selecting robot-assisted surgery in the marketing frame and not the evidence-based frame. This is the first study to our knowledge to demonstrate that words that highlight novelty have an important influence on patient preference for robot-assisted surgery and that use of more neutral language can mitigate this effect. 

It was Aristotle who long ago posited that persuasion is accomplished only in part by logical arguments (logos). Part of a persusaive appeal is relies on ethos, the trustworthiness and credibility of the person making the argument. In this case, that person would be the respected physician.  Another element of persuasion is pathos, an appeal to the audience's sympathies or imagination, often accomplished by a story that creates an emotional connection between the presenter and the listener.  Here, that story is delivered by a salesperson in terms of quality of life, drawing on anecdotes (not scientific findings) about patients who have been treated successfully.

As noted in this presentation from a college course (at Durham Technical Community College):

We can look at texts ranging from classic essays to contemporary advertisements to see how pathos, emotional appeals, are used to persuade. Language choice affects the audience's emotional response, and emotional appeal can effectively be used to enhance an argument. 

Thanks to authors Dixon, Grant, Urbach for confirming Aristotle's wisdom in the case of these new medical technologies.