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Fear Sells, Thoughtfulness Smells

a continuation from this post.

I am really not a fan of negative campaigning.  If candidate Jim would do a great job in office, then he should spend his time explaining why he would do a great job in office.  What turns me off (and I’d keep track of who does this and vote against them, except that everyone does this so it would be difficult to find anyone to give my vote) are those ominous voice-over ads that start with the creepy music while they show you a picture of candidate Suzy’s smiling face and then a voice says, “Suzy voted against the construction of a dog sanctuary, ensuring that thousands of dogs will be put to sleep each year.”  The ad then switches to a picture of a puppy dog looking directly at the camera with a single tear rolling down his face and ends: “Vote Jim if you love puppies.”

So you say to yourself, “Smelly Melly, you do love puppies, and this Suzy woman sounds like a real bitch if she doesn’t care about dogs.  You should vote for Jim.”

What the ad fails to mention is that Suzy voted against the dog sanctuary, instead using the funds to support an existing animal shelter.  She saved the town a great deal of money, protected the animals, and used existing resources rather than put money in the back pocket of the builder who lobbied Jim to support his sanctuary building project.  The ad uses big emotions — our love of puppies and our fears for their lives — and it takes a truth (Suzy voted against it) and twists it into a grey area by leaving out important additional information.  It’s a truth, but without much truthfulness.  And it sort of sucks when all the facts are revealed, and you realize how much your feelings were manipulated.

But we know negative campaigning works.  So candidates keep using it.

Negative campaigning isn’t unique to politics.  We see it in advertisements.  Buy this brand because that brand sucks.  Think about the popular Apple commercials showing the conversation between the Mac (Justin Long) and the PC (John Hodgeman).  The PC is always flailing about or failing for some reason or another — so the Mac looks damn good in comparison as he usually just stands there with his hands in his pockets.

My feeling has always been that if the Mac is a superior product, Apple should be able to tell me why they rock or how they’ll make my life easier or how it will benefit my work, and that argument should stand on its own.  They may need to compare themselves to a PC to show the difference, but comparisons are not always negative.  Sometimes, they’re simply neutral.  For instance, Apple does this with their current iPad commercials, showing us how this computer is unlike any other computer out there, and they do it without putting down any other computer in the process.

Neutral comparisons can be very helpful, and if I were in charge of the breastfeeding campaign, I’d write the slogan as “Breast First.”  Meaning, if it’s possible, aim to breastfeed before you consider other choices.  It doesn’t make commentary on the other choices, painting one the best and all others second-rate.  We live in a nuanced world where we know that when it comes to choices, first isn’t always the best.  I’m not married to the first boy I dated, I’m not still doing the first job I took, and I certainly didn’t use my first choice in family building.  (Though I did use my personal best choice.  Which won’t be the best for everyone else, therefore, I’d never declare it to be so.)

But we’ve seen through the effects of negative political campaigning and negative advertising that running a clean campaign isn’t as effective.  People don’t respond to information about what’s good unless the fire is lit under their ass with what is bad.  Got to have a bad guy if you want the world to rally behind you.  So my “Breast First” campaign will never have the same fire as “Breast is Best.”  It may serve to be less divisive by not ranking options, but like Jon Stewart’s rally (Rally to Restore Sanity) vs. Stephen Colbert’s (Keep Fear Alive), the fact remains that fear, dislike, and anger carry things a lot farther than comfort and kindness.

Which brings us to final point when we look at campaigning of any type from politics to brands.  All use forms of manipulation, which means to “handle or control in a skillful manner.”  Manipulation has negative connotations, but it’s not always bad.  A ceramic artist manipulates clay.  Parents manipulate their children towards good behaviour.  And some campaigning manipulates us towards a good choice.

But it does become dangerous when someone else is deciding what constitutes a good choice for you without knowing your specific circumstances.  Especially when — like negative campaigning — they’re appealing so deeply to your emotions, playing up your greatest fears. (I think Catherine Morgan did a good job explaining this in her post on flu vaccines.)  But is preying on your fears always a bad thing if it brings you towards a good choice?

I tried to come up with a grey example, and this was the best I could do.  Is it positive or harmful manipulation?  And do the ends justify the means?*:

A woman has gone through four IVF cycles with her RE.  Her diagnosis is still unexplained.  She has a good response to stims, creates a decent amount of embryos, and has gotten to transfer twice.  Both times, the embryos didn’t take.  She is 41.

She meets with the RE before her next cycle, and he admits that it’s baffling.  He’s frankly a little frustrated because on the surface, this seemed like an easy case, but something undiagnosable must be happening.  He really doesn’t want this woman to suffer needlessly — he is a kind doctor — so he suggests that she move to donor eggs.

The woman listens to about half of his thoughts before she interrupts and tells him that she wants to continue to use her gametes and she says the reason she wants to use her gametes is that it would make her parents happy.  The doctor, now cranky because the woman has rejected the careful arguments he was making for her own good — to save her heartache and money — now turns up the volume, using statistics that will support his case, and ignoring the few cases he can think of that negate his case.   He argues so passionately, that by the end of the appointment, the woman has tearfully decided to proceed with donor eggs rather than do another cycle with her gametes.

I could play both sides, argue that this is positive manipulation: the doctor is trying to save her heartache and money because statistically, it is more likely that she will conceive with donor gametes and he knows it’s a child she wants.  If he tells her about those four miracle cases he also knows about, she’s going to focus on the four miracle cases and not the bigger picture which is that donor gametes is a better road for her.  He believes that she isn’t making sound choices for herself.

But it’s also clearly also negative manipulation: the woman knows what she wants and he bulldozes over her feelings in order to “help” her.  He doesn’t give her all the facts and allow her to make her own decisions or even be a true player in her own treatment.  If she wants to focus on having a miracle, that’s her right.  There may be reasons the doctor cannot begin to fathom for why she’d want one path over another — she has shared but one, and only the patient knows the full picture about her life.

What do you think?  Is it more positive or negative manipulation?

Would you be okay being nudged in one direction if that nudge was in a good direction, even if the facts were withheld or misquoted to you?

Any time we try to influence another person — and we do it every second of the day — we are performing manipulation.  But just to be clear, I am differentiating between that positive, greyish manipulation in the example and the negative manipulation of that first example of the attack campaign ads.  I think most of us would say that we don’t stand behind the latter, becoming cranky when the truth is twisted so deeply that it doesn’t resemble facts anymore.  That is the type of comment I would hold for approval, asking for a link that supports the statements made.

But thinking about that situation made me wonder how I feel about the former, that really grey area that comes from a good place, though may do damage simply because your life is being influenced by people who don’t know your personal circumstances?  I don’t think there is one clear answer.

* This is an example I created.  In other words, if you are seeing yourself in this example, step back — it isn’t grounded in reality at all and you shouldn’t use it to make any decisions about your own life.


1 Merri Ann { 10.04.10 at 11:22 am }

I was in this exact situation … my husband and I talking about conception to a VERY successful and experienced infertility specialist … me at the rip ole age of 42. We’d been trying on our own for 10 years and now the real reality of our waiting staring us in the face. Only our doctor stated just the facts, explained what the statistics were, gave us real life experienced examples … no opinions … no judgements. This was huge.

In this circumstance, it was necessary for us to be able to make a decision WE would able to live with. We were fortunate to have discovered such a great doctor.

It is distressing for me to think that women are being poked and prodded to make decisions that benefit family members or doctors opinions. Some of the best advice we received was this (from our infertility specialist) “… keep this whole process to yourselves … don’t feel the need to tell everyone … everyone is going to have an opinion … and a story about someone who suddenly became pregnant on their own after years of treatments. Ultimately the decisions need to be yours … you have to live with them.” For us, this turned out to be good advice.

Great post !!

2 MLO { 10.04.10 at 11:24 am }

You just didn’t realize that Breastfeeding v. The Bottle is Godwin’s Corollary. I’m in the midst of writing my post about that.

3 Melody { 10.04.10 at 11:30 am }

Funny that you use this example because I DO see myself in it. My first IVF failed in exactly this way. I stimmed great, got a terrific clutch of eggs, and 17 of 21 of them fertilized without ICSI. The only difference was that I did NOT get to transfer because all 17 arrested in the first 24 hours. The RE concluded that my eggs were bad, and we switched to donor egg (using my partner -at the time-‘s eggs). I miscarried from that cycle, which THEN led him to do the immunology work-up that led to my real diagnosis, for which there was a treatment protocol. Subsequently I conceived during a medicated IUI using my own eggs. My partner and I split before I was out of my 2nd trimester because she decided she did not want children.

Given this experience, and several others I had throughout the course of fertility treatment, I think its crucial that patients have access to all of the information, not just the info the doc thinks prudent to provide. Had I known that there was an additional $1500 out of pocket test that I could have taken that might have provided some clues as to my real diagnosis before that second donor egg IVF, I would certainly have chosen that option rather than pay another $12K out of pocket for an additional IVF. His witholding information– even though I believe him to be a great doctor– cost me a lot of money, pain, and heartbreak.

4 Katie { 10.04.10 at 11:40 am }

As much as I bitch and moan about wanting to know what the “right” decision is regarding our next step, I get irritated when I’m pushed in one direction or another – by doctors, by friends, by family members, etc. Oddly enough, I wrote a post last week about my experience at a conference where both REs and adoption agencies were present (and the nudging that went on from one side; the post is still sitting in my draft folder). I don’t want to be pushed into something I’m not sure about, and I try my best not to do that same thing to others. I do think that some people have your best interest at heart, but I feel like the only person who truly knows you and understands what you want/need is you.

5 Dora { 10.04.10 at 1:20 pm }

Great post. Love your slogan, “Breast First.” True, it’s not as powerful, but it’s more accurate and kind.

But, damn! Melody’s experience makes me so angry. I had read about experiences like hers on IVF message boards, so before my first scheduled IVF cycle I (without informing my RE) got a recommendation for a hematologist and requested he run immune and thrombophilia tests. And I wonder if my daughter would be here today if I hadn’t requested a test of my progesterone levels on transfer day to be sure I was absorbing the vaginal progesterone well enough. I wasn’t, and immediately switched to PIO shots.

6 Tara { 10.04.10 at 1:22 pm }

When I was finishing highschool & having to decide what I wanted to study in college I just wasn’t sure…my family & friends incessantly nudged me to pursue Gerontology. Though I had an interest, I wasn’t passionate about it…I wasn’t accepted into the program that 1st year so took a General Arts & Science program so I could reapply the following year since everyone was constantly saying, “you’d be so good at that!!” During the general arts program I had the opportunity to dabble in a variety of subjects & loved & exceled in the finance/business/accounting classes. My teachers told me I had a talent & could really go far…enter my family & friends insistant nudging that I was made for Gerontology & would be so good at it…the following year I was accepted into the Gerontology program & did well, got a job right out of school & did well…but I wasn’t happy. I didn’t have a passion for it & working with seniors takes passion! Lo & behold the nonprofit company I worked for went belly up…that’s when it dawned on me that just because I’m good at something doesn’t mean I have to make it my career…now I am working in the Finance field and LOVING it! So being nudged in one direction, even though it was “good” for me wasn’t the right choice…I could have done so much more in my career if I had followed my heart & pursued Finance/Business/Accounting in the first place.

7 a { 10.04.10 at 4:01 pm }

There are times when I don’t want to make decisions, and I will accept the manipulation. Those times are few and far between. Any time someone pushes me in a direction I haven’t decided to go, I push back. I do not appreciate being led to a particular decision.

Everyone has an agenda. Whenever someone is advising you to do something, you can bet that they know the information regarding the opposing advice, and generally they withhold that information. I don’t know whether that’s positive or negative manipulation – I guess it depends how you would feel if you knew the information that was withheld. I also think we have a responsibility to do our own due diligence, so we are not as susceptible to the manipulation. The thing to remember, though, is that statistics can say almost anything you want them to say – it’s all about interpretation.

I do like your “Breast First” idea – and I don’t know that it would be more or less effective than the current campaign. Couple that with proper lactation support, and you might just have something.

8 luna { 10.04.10 at 6:05 pm }

I’m all about making informed choices.
I want all the information and I want to be trusted to make my own decisions, based on what is right for me. Of course I’d want my doctor’s recommendation, but I’d also want to know that s/he supported what was best for me under the circumstances.

9 luna { 10.04.10 at 6:06 pm }

p.s I do love the “breast first” campaign.
not as catchy, perhaps, but it does what it’s supposed to without all the rest.

10 Bea { 10.04.10 at 7:23 pm }

First of all, I don’t think the donor campaign is analogous to the breastfeeding campaign. I’m not sure if you were trying to make an analogy. It’s relatively easy for a health care professional to objectively evaluate breastmilk over formula in any given situation, taking into account the logistics of any necessary pumping, etc etc. (It’s also easy to switch to plan B halfway through if you get the calculations slightly wrong.) By contrast, a health care professional is in no position whatsoever to evaluate what constitutes your reproductive goals (and it’s almost impossible to switch to plan B halfway through – can you imagine trying to disentangle yourself from a relationship with your donor-conceived 4yo in order to go back to your own gametes at 45 or 46yo?).

In the breastfeeding campaign, the facts are relatively clear and objective, the goal being to feed the child the best quality food under whatever practical constraints exist. In the donor egg campaign, the goals are less clear and more personal. Perhaps, for some couples, there may not need to be a child at all.

So all this is to say that whilst I see a real place for balanced and value-neutral guidance by health professionals on matters such as feeding your child, I don’t see it as the place of the reproductive specialist to tell you how (or whether) you should build your family.

As for manipulation that comes from a place of beneficience – paternalism, in other words – I think there’s a place for it in the world, but it’s a very limited place. When my Grandma sneaks five dollars into the purse of my elderly Great Aunt so she can “pay for her meal” even though a) $5 isn’t enough these days and b) she’s too confused to properly handle money anymore so her purse is always kept deliberately empty and her finances managed entirely by her son, this is all good. When you’re talking about a medical professional with a fully competent adult human being and especially when you are talking about life-changing decisions, you are talking about a situation where all the facts should be revealed and openly discussed in a neutral manner.

This doesn’t mean a doctor can’t give a recommendation (together with her/his reasons for it) and the doctor may even give a rating as to the strength of the recommendation (I strongly advise…). This is especially to be encouraged if the patient expressly asks for a recommendation. However, there needs to be an (explicit) acknowledgement that this recommendation is based on certain (specific) values that the patient may or may not share, and that the patient ultimately must make the final choice. (There is also an – again limited – place for the doctor to bring to light the points of view of other affected parties – in this case, the donor and the potential child, plus any existing family members. This is not to say that the doctor should speak for them, but I think it’s ok to point out that these people exist, and maybe to encourage some reflection on what these people might think and how important their thoughts should be.)

Finally, I think big decisions should always be made slowly and after receiving more than one opinion. This will enhance your understanding and help neutralise any overt biases, including the bias towards protecting what the person sees as your own welfare above all other goals.


11 Bree { 10.04.10 at 7:40 pm }

Along the line of the Rally to Restore Sanity signage ideas, you could try “Breast First: Because Who Knows… It Might Be a Workable Choice for You and Your Family” or “Breast First: But You’re Not a Bad Mom if You Have a Plan B”…

I like where you’re headed with this, as per always.

12 Fearless Formula Feeder { 10.05.10 at 2:07 pm }

You’ve pretty much hit upon the crux of my whole “platform” when it comes to breastfeeding campaigns, actually. And while I see Bea’s point, I have to disagree. I don’t think policy makers (or the ad council) have a place in weighing relative risk, which is what breastfeeding decisions often come down to. In your IVF example, it’s also about relative risk and personal choice. They are one and the same. And as another commenter posited, statistics can be manipulated to serve a purpose, which makes it easier to manipulate…

I kind of feel like no manipulation is ”positive”. We should be laying out facts for people impartially and letting them make their own decisions. Especially when it comes to parenting, b/c parents are already so vulnerable to manipulation… we’re a nervous, insecure bunch, as is.

13 annacyclopedia { 10.06.10 at 12:58 pm }

Mel, I’m still mulling over your posts on breastfeeding from last week, and like you touch on here, I think they are really about something bigger as well as all the issues you raised so well in those posts. And I think in reading this post that you have identified the thing I haven’t been able to quite reach in all my mulling – it’s about reaching out and helping other people without manipulating them. For example, I would consider myself very pro-breastfeeding, and I want to help support other women who want to breastfeed, and I do believe that breastfeeding is normal and that we should improve the rates of breastfeeding in Canada and the US. BUT…I hate the way that it has become another way to make mothers feel like crap, that it is something that is fraught with guilt and shame and feelings of failure because, in large part, of the campaigns like Breast is Best and because of the more subtle forms of manipulation you talk about here.

I have more to say about this but I think I’m going to mull some more and work on a post about it – things are not quite clear enough for me yet. But right now, my gut says that that it is not okay to manipulate someone into making a choice, even if it is a good choice. I think I am feeling that way because I feel we need more honesty and more clarity in our public and personal discourse, not less. It’s not as simple as letting people make their choices in a vacuum, or abandoning them to figure things out on their own, but rather an awareness on the part of the person trying to help of what agenda we might have, and how we are offering our help or advice. Are we doing so freely and without condition, or does our love, respect, care or esteem for the other person hinge on their agreement with us?

Thank you, as always, for fostering sane discussion and for expanding the way I think about some of the things that are most important to me. You are amazing and I absolutely adore you.

14 Jodie38 { 10.06.10 at 6:11 pm }

Whooee, that’s an awfully grey area isn’t it? At it’s worst, it’s malpractice. But I’m sure it happens all the time, in some form or another, to some degree or another. We can’t possibly know where another person is truly coming from, whatever side of the table we’re sitting on. Patients absolutely have to be their own advocate, to the best of their ability. At this level of medical intervention, it’s easy to get railroaded by a bad doctor. And I honestly think most RE’s are not in this to screw people over., but there’s always someone to ruin it for the rest of us, isn’t there?
I ultimately used donor eggs, and my experience was exactly like that of your first commenter, Merri Ann. At the damage control meeting after our most recent failure my RE closed my chart, folded his hands on top of it and we just had a sincere chat. He gave me the statistics, where I was landing in them, said we could do this as long as I wanted to. He told me to search my own heart and motivations, and get back to him. Took me about eight months, but I ultimately went with donor eggs and I never once looked back. But it was my decision, all the way.

15 Roccie { 10.06.10 at 9:29 pm }

* Hilarious clarification as I felt my heart rate increasing. Ha. You couldn’t pay me to go back to my old ass eggs.

Great post with an excellent challenge. Thanks.

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