Saturday, December 18, 2004

Smokers don't think elephants (or anything else, apparently)

Many of us were dismayed when polls indicated a substantial portion of the American public continued to believe that WMDs were found in Iraq despite widespread reporting to the contrary. Well public healthniks, prepare to be dismayed again.

A survey in Nicotine and Tobacco Research's December 2004 issue (and reported by Reuters Health) found that 94% of smokers consider themselves well informed about the risks of smoking, but halfof those did not know the risk of heart attack was higher among smokers. One third agreed with the statement, "Cigarettes still have not been proven to cause cancer." The study authors point out this indicates the tobacco industry defense that most smokers are making a well-informed personal choice is false. But that's not what I want to talk about here.

Putting dismay aside (a pretty tall order, but try it), what do these results mean? I can't think of a simple explanation. Stupidity is too facile and condescending. Not everyone is the sharpest knife in the drawer, but the prevalence of these mistaken beliefs is too high and is repeated in too many other areas where ignorance remains in the face of a wide consensus on the facts. Any other possibilities? Addiction, surely, but it doesn't explain the mistaken beliefs, unless addiction has additional features not usually attributed to it.

This finding reminded me that George Lakoff, the cognitive scientist whose ideas on the importance of linguistic framing are au courant these days, likes to say that "facts don't matter" when they conflict with a subject's strongly held cognitive frame. Lakoff's ideas are much debated because he has applied them to politics (see his books Moral Politics and recent don't think of an elephant!). But it strikes me they might be useful in public health independently of their validity in politics (for the record, I know Lakoff and am impressed with the explanatory power of his ideas in the political realm, but their appropriateness and applicability there seems to me a separate question). Lakoff's elephants book is his most accessible (punchy and short). If you are not enamored of his political persuasion put that aside and translate the political to a public health context.

The importance of the Lakoff perspective, in my mind, is that it directs our attention, also, to the"frame" we use in crafting public health messages, which in turn requires us to consider the implicit values of public health. Lakoff reminds us that it is not only the cognitive frame of the receiver of the message but also the frame of the sender that matters.