Slow e-motion; big things and manners in internet health debates

Nick Broughton

Pharmaceuticalethics.com

In this article, Nick Broughton reflects upon last month’s discussion of ‘Bad Pharma’ with Ben Goldacre and shares his thoughts on the importance of good manners during debates like this on social media.

(Continued from “Bad Pharma by Dr Ben Goldacre, the mechanics of a mediocre argument”)

One of the more hefty crosses yours truly has to bear at the moment is a grimly devout loyalty to Blackburn Rovers, once of the Premiership, currently mid-Championship and sinking. I made an Ewood Park pilgrimage just last month to sit in the rain and watch an ultimately futile battle with Millwall. It was at that match I had something of a revelation. Immediately as the game kicked off, the gentleman directly behind me began to scream as a person possessed at the players and officials on the pitch with as much venom as his actually quite elderly lungs could muster. They could muster a lot. Each Rovers player was given immediate advice when on the ball as to what he should do with it, and the officials had their parentage questioned closely and succinctly each time they had the temerity to suggest the home team had transgressed the sacred laws of football.

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“Firstly, it is important to recognise the ‘big thing’ that motivates your debating opponent.”

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This is not unlike debates in social media, as I reflect on the discussion I had with Dr. Ben Goldacre last month. One or two people with strong views spouting off at length in front of a large group of people they don’t know. Most of the observers sit bemusedly on the periphery murmuring agreement whilst one or two join in loudly with their own reflections. Across the park, someone with an opposing Cockney view spouts off amongst his fellow believers. The debate rages briefly (Blackburn lose again) and we all trip off back to our homes a little bit more weary but still in the same place on the debate: Blackburn are better than Millwall, Millwall are better than Blackburn. So here’s the question, shouldn’t our healthcare debates in social media be more than a chant for our current team, and if so, what should they be and how do we get there?

For those of you didn’t see it, here is a quick précis of last month’s debate from my perspective reflecting the play of my emotions through the day or two it took place (I really can’t and won’t speak for Dr Goldacre).

Broughton [In article], It really hacks me off when people unjustly label the whole of the pharmaceutical industry as morally bad based on examples of bad behaviour when they have not considered or adequately given credit to the good. Dr. Goldacre has done this in ‘Bad Pharma’ I wish he wouldn’t.

Goldacre, First reply at length

Broughton [Emotion – dismay], You’ve got completely the wrong end of the stick old chap, can understand it from one paragraph but please refer to the bits of my article that contradict your belief. Can we get back to my main point.

Goldacre, Second reply.

Broughton [Emotion – actually pretty angry now], For goodness sake I agree with you

Goldacre [Yet further reply], Third reply

Broughton [Emotion – exasperation], Whatever

Now let’s be clear I’m not wishing to reopen last month’s debate, but rather would like to consider the mechanics of it and where perhaps, without losing all the argy-bargy that makes it interesting, it could have gone a bit better with more constructive a conclusion from my perspective.

Firstly, it is important to recognise the ‘big thing’ that motivates your debating opponent. I have two big things. The first is that I believe passionately that compliance cannot be achieved without an understanding of morality (I’ll do more on this some other time). The second is that the pharma industry should robustly defend its moral position against those who, often hypocritically, categorise it as somehow unworthy. Dr. Goldacre’s big thing (he may have others) is missing data which he rightly points out can mean that we don’t properly understand the medicines we are using.

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“This problem of not taking time to consider the perspective of your debating partner is compounded to a large extent by the necessity to overstate your case in order to be heard.”

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The importance of recognising your opponent’s motivator is that it will undoubtedly be from that perspective that they look at your work. Dr. Goldacre wrote a book called ‘Bad Pharma’ and to me, with my second big thing in mind, it’s a personal slur, it’s all I see, and I have to kick back. To Dr. Goldacre, that’s probably just a succinct title for a book that is really about certain aspects of behaviour in pharma he would passionately like to see improved. Looking from that perspective, I have more understanding. Similarly when in my article I wrote about historical issues of missing data I shouldn’t be surprised that Dr. Goldacre interprets that as suggesting I’m denying it is current – it’s his big thing, he is sensitive about it and it’s all he sees.

This problem of not taking time to consider the perspective of your debating partner is compounded to a large extent by the necessity to overstate your case in order to be heard. A book entitled ‘Pharma bad in parts, good in parts’ doesn’t really get the emotions going sufficiently to buy a copy. I called Bad Pharma a ‘mediocre argument’ in part because I calculated that ‘mediocre’ was about the worst thing I could call it and more likely to get a response, as indeed it did.

Recognising your opponents’ motivators is one thing, but more important still, if debates are to achieve any worthwhile conclusion, is to acknowledge them and act on them. Truth is, if I am going to achieve anything in terms of the wider world looking at pharma with a more kindly eye I am going to need people like Dr. Goldacre speaking for me. If Dr. Goldacre is going to achieve his goal of greater data transparency he will find that much easier to achieve with a listening pharma industry working with him. The point here is that until we learn to stop beating our own drum for five minutes and to act upon the passions of others we just won’t get anywhere. It’s really about manners, about putting someone else’s big thing ahead of yours at some point out of courtesy. Heated debates are good to get underway, but after the initial fracas I’m not sure we’ve yet established any manners with which to move things on. Too many people are simply shouting at each other from the terraces.

So here’s a few social media debate manners to which you are welcome to add (or indeed disagree):

1. Assume a good person is writing it

This can be difficult in some social media settings, but surely in pharma forums we’re on reasonably safe ground to assume the person at the other end isn’t such a bad egg. At least assume people are good until you have hard evidence they aren’t. It’s occurred to me before that we have a tend to over-trust people when face to face and overly mistrust those we cannot see.

2. Disagree with the argument, don’t abuse the person

It’s very easy to slip into the odd barbed comment about the character or intelligence of your opponent. In pharma debate circles, people tend to avoid swearing but replace the oaths with fancy words meant to be just a hurtful.

3. Read everything properly

When in the heat of a debate there is a tendency to reply after a quick read of your opponent’s argument. Avoid this – read everything properly as your skim read is guaranteed only to identify the bits that hack you off.

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“Put aside the main driver for your involvement in an internet debate and at least consider whether you can help your opponent…”

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4. Check for understanding

In discussion we naturally check for understanding as we go along. If someone says something I disagree with it becomes clear pretty quickly if I’ve got the wrong end of the stick. In social media this is more difficult but not impossible, before you write your weighty response make sure it’s addressing a point that has been made.

5. Re-tweet people who disagree with you

In the debate above there was a bit of twitter action on both sides of the argument. One persistent critic of pharma tweeted an article about complicity theory as an explanation for why good people do bad things which was fascinating, so I re-tweeted it (my following is pathetic so you may have missed this). This I’ve come to believe is a good thing to do as if nothing else it confuses your opponents as they wonder if they have accidently said something helpful to you. The other thing it does is demonstrate you are listening to those who don’t agree with you.

6. Help your opponent with their big thing

Back to my original and main point. Put aside the main driver for your involvement in an internet debate and at least consider whether you can help your opponent with what is motivating their involvement because often the motivations are different and not necessarily contradictory (as in my example with Dr. Goldacre above).

In that spirit and to those ends, I’m going to give my next piece in this journal over to a consideration of the moral issues involved when data is lost or hidden intentionally or unintentionally from public view and consider in more depth why this is morally wrong. It will be good for me as it’s not something I’ve considered before but I’ve no idea how it will turn out and it might be rubbish. I will at least though have given time to considering someone else’s perspective and their big thing, c’mon Millwall.

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About the author:

Nick Broughton is Managing Director at Pharmaceuticalethics.com.

Dr Nick Broughton qualified at Nottingham University Medical School and worked in hospital medicine and primary care for a period of seven years before joining the pharmaceutical industry.

His first role was as a clinical research manager in phase II and III at studies Sanofi Winthrop before moving into a medical adviser role at MSD UK.

The majority of his pharmaceutical career has been at AstraZeneca where he was UK Medical Affairs Manager before becoming UK Head of Medical Affairs. He then gained over 2 years international experience as European Director of Regulatory Affairs.

Nick is co-founder of Pharmaceuticalethics.com, a company that provides ethics and compliance audit, education and consultancy services to pharma and allied agencies.

How important are good manners during social media debates?