Salience Is Huge

Dr. Feldman

Like me, many of you probably had not heard of Jamal Khashoggi, a Saudi Arabian journalist, until after his death. He was killed last month at a Saudi embassy in Turkey, according to news reports. Now Mr Khashoggi, whose articles criticizing the Saudi government got him exiled from that country, is all over the news. Turkey’s president, Recep Tayyip Erdogan, said of this episode, “Covering up this kind of savagery will hurt the conscience of all humanity.”1

I bring this up because it illustrates how one salient story has more impact on human thinking than a boatload of data. As the Khashoggi story unfolds, an enormous tragedy is taking place in Yemen. The United Nations reports that 22 million Yemeni people, 75% of the Yemeni population, need humanitarian aid and protection.2 Over 8 million citizens don’t know where they will get their next meal. Roughly half the population doesn’t have access to clean water and basic hygiene. And 2 million people have been displaced, while 2.9 million children and women are acutely malnourished. Despite this data, the US Congress seems far more moved to action by the horrible death of one Jamal Khashoggi and not by the enormously greater horrors, the savagery, happening to people in Yemen.

Being moved by one salient example is something that comes up in medicine regularly, although not usually on this kind of geopolitical scale. I recently suffered the onset of a very painful case of sciatica. Sleepless nights in pain gave me plenty of time to search UpToDate for how sciatica is best treated; there’s little that can be done for it that is better in the long run than doing nothing. But then one of my colleagues told me that prednisone was a dramatic help for his spinal issues. Within hours I had contacted my gerontologist’s office, gotten the prescription for prednisone, and started the treatment. The fact that I had already seen the data that steroids don’t do a lot for sciatica didn’t have any deterrent effect.

Humans have an enormous capacity for empathy, but it is for salient individuals, not for statistics. When we want to help patients make a choice of treatment, we could give them a lot of data. We could give them all sorts of clinical trial data on efficacy and safety. Or, we could just tell them, “You know, I had a patient whose disease was just like yours. And he/she did really well on drug X.” That kind of brief anecdote is likely to have far more effect on our patients’ thinking than clinical trial data.3 Anecdote moves people more than any kind of statistics. 


Steven R. Feldman, MD, PhD
Chief Medical Editor

Dr Feldman is with the Center for Dermatology Research and the Departments of Dermatology, Pathology, and Public Health Sciences at Wake Forest University School of Medicine in Winston-Salem, NC.

References

1. Fahim K, El-Ghobashy T, Hudson J, Harlan C. Trump says Saudis engaged in ‘worst coverup ever’ as U.S. imposes penalties. Washington Post. October 23, 2018. https://www.washingtonpost.com/world/turkeys-president-to-deliver-speech-expected-to-describe-how-khashoggi-was-killed/2018/10/22/4098c300-d60c-11e8-8384-bcc5492fef49_story.html?noredirect=on&utm_term=.ad9d8691c7a0. Accessed October 26, 2018.

2. United Nations. Yemen. https://news.un.org/en/focus/yemen. Accessed October 26, 2018.

3. Oussedik E, Patel NU, Shukla S, et al. Anecdotal and clinical trial evidence increases patient willingness to consider biologic medication in psoriasis. J Am Acad Dermatol. 2018;79(suppl 1):AB43.