“Psychological manipulation is a type of social influence that aims to change the perception or behaviour of others through underhanded, deceptive, or even abusive tactics. By advancing the interests of the manipulator, often at another’s expense, such methods could be considered exploitative, abusive, devious, and deceptive. Social influence is not necessarily negative. For example, doctors can try to persuade patients to change unhealthy habits. Social influence is generally perceived to be harmless when it respects the right of the influenced to accept or reject and is not unduly coercive. Depending on the context and motivations, social influence may constitute underhanded manipulation.[i]”
I find this definition of psychological manipulation from Wikipedia very interesting, not least the comment following on from, “exploitative, abusive, devious, and deceptive,” being the addition that, “Social influence is not necessarily negative.” The example given to justify this is, doctors, using psychological manipulation ‘to change unhealthy habits.’ However the circle completes with, “Depending on the context and motivations, social influence may constitute underhanded manipulation.”
This raises a number of questions, particularly when applied to the issues which surround the use of alternative, smokeless, recreational products. (E.g. E cigarettes, snus etc.) What if some of our doctors are also victims of [negative] psychological manipulation and are being used as a conduit because of this? What if doctors have failed to be impressed by attempted psychological manipulation but remain the unwilling channel for the dissemination of misinformation? And if doctors are being used to disseminate: exploitative, abusive, devious, and deceptive messages with regard to smokeless tobacco, recreational products and harm reduction in general, what is the source of this information – what motivates the source, and, what are its social implications?
So, are doctors the target of psychological manipulators? To answer this I think I should try to establish the nature of the manipulation and who stands behind it.
This is a story which goes back a long way, in fact for my purpose, back to 1914 and the UK Government’s Select Committee investigation into the dealings of the pharmaceutical industry.[ii] The 2014, Select Committee Fourth Report makes reference to the 1914 Committee findings
“After careful consideration of the evidence laid before them your Committee find:
(1) That there is a large and increasing sale in this country of patent and proprietary remedies and appliances and of medicated wines.(2) That these remedies are of a widely differing characters, comprising (a) genuine scientific preparations; (b) unobjectionable remedies for simple ailments; and (c) many secret remedies making grossly exaggerated claims of efficacy…(3) That this last-mentioned class (c) of remedies contains none which spring from therapeutical or medical knowledge, but that they are put upon the market by ignorant persons, and in many cases by cunning swindlers who exploit for their own profit the apparently invincible credulity of the public. (4) That this constitutes a grave and widespread public evil…”
I would like you to focus on, “…cunning swindlers who exploit for their own profit the apparently invincible credulity of the public. (4) That this constitutes a grave and widespread public evil…”
This was 1914, and cannot possibly refer to the huge, modern pharmaceutical corporations who, ‘use’ science as a base for all they do – can it?
Well, why is it included in the Forth report? Simply this, just as ‘swindlers’ gave out false hopes, the present gigantic pharmaceutical industries play on people’s fears and anxieties.
“People have been taking ineffective and harmful medicines for centuries. However, there is reason to fear that the industry has positively nurtured anxieties about ill-health. The fundamental problem, it is alleged, is that the industry is increasingly dominated by pressure from its investors and the influence of its marketing force and advertising agencies rather than its scientists. The industry is hugely influential, affecting every aspect of the medical world, including prescribers, patients, academics, the media, and even the institutions designed to regulate it. Its influence in Parliament is extensive… It is claimed that pharmaceutical companies encourage us to see ourselves as ‘abnormal’ and thereby requiring (drug) treatment. They have a powerful incentive to do so; the more people who see themselves as suffering from a medical condition, the larger the market and the greater the profits.”
Pharma exerts massive influence, “affecting every aspect of the medical world, including prescribers, patients, academics, the media, and even the institutions designed to regulate it.” And these are the utterances of the UK Government Select Committee, not mine. So where does this fit into the definition of psychological manipulation? As a reminder, “Psychological manipulation is a type of social influence that aims to change the perception or behaviour of others through underhanded, deceptive, or even abusive tactics. By advancing the interests of the manipulator, often at another’s expense, such methods could be considered exploitative, abusive, devious, and deceptive.”
Are the tactics employed by the pharmaceutical industry, underhand? Well, yes. Take for example, ghost writing. Ghost writing has a number of definitions, but the one I am interested in has to do with medical research papers which are written by someone not acknowledged in the article and who are engaged by pharmaceutical companies who have a vested interest in the content. It is difficult to estimate just how far this practice exists, but exist, it does. “…the practice of misleading readers about potential competing interests and hiding contributions to a published work, no matter whether these contributions should be most appropriately disclosed in the author by-line or acknowledgements section, is unethical and totally unacceptable.[iii]
It has now got to the level where ghost writing is being openly ridiculed. In, HARLOT plc: an amalgamation of the world’s two oldest professions[iv], we find…
“Once your data are sufficiently cooked, it is time for us to help you write them up. Our “Ghost Writers in the Sky” have perfected the “Johnny Mercer strategy” for reporting indeterminate trials:
We “accentuate the positive” by reporting only favourable subgroup analyses. Moreover, you don’t have to settle for just one paper in just one journal. For no extra charge, we will randomise the sentences in the original article and submit the suitably camouflaged duplicate publication to a second, unsuspecting journal. Additional publications (our current record is 42) are available for correspondingly higher fees, but we warn you at the outset that these fees will be multiplied by a DVF (déjà vu factor).
We “eliminate the negative” by omitting or burying all unfavourable results where nobody can ever find and report them. After all, what they (patients, clinicians, regulators, and the public) don’t know can’t hurt you. We have a contact in the Wieliczka salt mine who can guarantee burial of negative results 200 metres underground.
And we definitely “don’t mess with Mr In-Between.” We stay out of the DMZ (disappointing, minimally important zone) by suppressing equivocal results and bothersome confidence intervals. We report only relative risk reductions when absolute risk reductions and numbers needed to treat (NNTs) reveal that your drug really isn’t worth a bean.”
Humour aside, ghost writing is underhand, and is encouraged by the pharmaceutical industry. Where ghost writing occurs in medical journals, it is aimed at deceiving medical practitioners and scientists and the regulatory bodies, as well as providing ammunition for the multitude of health organisations and medical charities. It is designed to change the perception of these audiences in order to further the ends of the pharmaceutical industry, and in the case of alternative, smokeless, recreational products, is very much to the detriment of those who would have switched away from tobacco cigarette smoking, but were put off due to the publicity generated by articles written by agents of the pharmaceutical industry. This fits neatly the definition of psychological manipulation.
Closely aligned to ghost writing, and with similar aims, are the activities of Key Opinion Leaders. (KOL’s) Indeed, one of the tasks of some KOL’s is to actively participate in ghost writing activities. But first, what are KOL’s and what is their purpose? How are they recruited and how are they managed? Oh! And how are they rewarded?
KOL’s are not a homogeneous group. They can be sub-divided (for my purposes) into two different categories. The first group, the ones at the bottom of the pecking order, are general practitioners, though some others may well be specialists. Above them, at the top of the tree, we have the researcher KOL’s. Amongst this second group the pharmaceutical companies, or their agencies, work very hard to train them, where they are developed into ‘product champions.’
The general practitioner KOL’s serve to speak to other medical practitioners at dinners, lunch time talks or other medical events – which are mainly organised by pharmaceutical company representatives. Let us face it; the word of another doctor is going to carry more weight that the sales pitch of a company rep. One US newspaper, in Tampa Bay, reported on the activities in that area, and it makes for very interesting reading. It demonstrates just how important these KOL’s are to the pharmaceutical industry. http://www.tampabay.com/news/health/medicine/drugmakers-willing-to-pay-to-get-doctors-approval/1031817 and there is a great deal more. “Filed reports from only seven companies, made public as a result of legal actions, have revealed that hundreds of U.S. physicians are paid more than $100,000 each year and that many more are paid more than $10,000. such amounts could hardly be justified by the value of the recipients’ own prescriptions.”[v]
Another indicator of the importance of KOL’s is the length that the pharmaceutical companies will go to in order to identify and then groom potential candidates, after which, the degree to which they are trained, and finally, the way in which they are controlled. For a description of this – and more, go to and read, Key Opinion Leaders and the Corruption of Medical Knowledge. It can be found here, http://onlinelibrary.wiley.com/doi/10.1111/jlme.12073/pdf
(The important word in the above title is ‘corruption.’)
This corruption has been facilitated through an industry’s cynical infiltration of a whole profession where it can manipulate the thinking and actions of that profession. It does so through lies and misrepresentations at all levels within the medical world. We have corruption through ghost writing, leading to the seduction and manipulation of, medical practitioners, and further up the scale, of researchers, academics and other ‘product champions,’ influencing, not just medical practitioners, but the media and politicians, and worst of all, the general public who are the object of this hidden, but frenetic activity. The ones who suffer as a result of false science and the false hopes raised in them through this false science and it all boils down to the application of very sophisticated psychological manipulation: So sophisticated in fact, that many of the manipulators, indeed, appear to believe their own lies.
Once again may I remind you of the important adjectives in the definition of psychological manipulation? They are: ‘exploitative, abusive, devious, and deceptive.’ It would appear that the machinations of the pharmaceutical industry well and truly fit the bill, in fact, the more I see of Pharma, the more I wonder if the definition of, psychological manipulation, was created just for them. May I emphasise what the definition also says. “Social influence is generally perceived to be harmless when it respects the right of the influenced to accept or reject and is not unduly coercive.” I will now attempt to analyse this comment, particularly in the light of the development of alternative, smokeless, recreational products, and with particular emphasis on, ‘unduly coercive.’
The first aspect of the definition which pains my eyes is the switch from the use of, ‘psychological manipulation’ to, ‘social influence,’ when about to discuss the role of doctors and their attempts to persuade people to avoid ‘unhealthy’ habits. From this comment, I perceive that the psychological manipulations by the pharmaceutical industry have even found their way into the creation of caveats in the definitions of the term in mainstream dictionaries. How can the views of doctors be merely considered ‘social influence’ when the driving forces behind them are out and out attempts at psychological manipulation? And worse, what if the advice being given is not good for the recipient of that information? How can this be harmless?
And this brings us to the example of alternative, smokeless, recreational products, and in particular, e cigarettes. I will concentrate on this phenomenon, but It has to be added here that snus is also shining example of the good which Harm Reduction products can create: In fact one of the ‘manipulations’ of Pharma is that there is no real evidence of the effects of harm reduction – we need long term studies. Well, in snus there are, ‘long term studies,’ and they are very impressive indeed[vi]. (A couple of links discussing snus and its effects are provided in the end notes) But most people may not have heard about snus, though they have heard about e cigarettes, and because of the furore they have generated in the media, the public have at least a basic (often misguided) understanding of what they are – if not what they do.
Make no mistake, the pharmaceutical industry are terrified of e cigarettes and the level of threat they present to their profits. It is so bad; they have even joined forces with the major tobacco companies in order to ward this threat off; not that this prevents each from following its own agenda when the situation proves beneficial to one or the other. So now we have tobacco companies producing smoking cessation products, and the pharmaceutical industry, through its psychologically manipulated satellites, simply pretending to hate Big Tobacco, but making sure that the actions it takes generate maximum publicity while achieving virtually nothing. https://brainyfurball.wordpress.com/2014/06/21/tobacco-control-a-wolf-in-sheeps-clothing/ it is a symbiotic arrangement which is designed to guarantee the continuance of tobacco smoking, and in particular, its attraction to a considerable number of young people. As long as the public, in general, do not see this…
Well, they will not, that is what psychological manipulation is all about, and both Tobacco and Pharma are world leaders in the field.
The main attack on e cigarettes by Pharma has come via organisations like the British Medical Association and its endorsed journal, the BMJ. Indeed, this is the official journal of the BMA. Equally, e cigarettes have been attacked by a myriad of medical charities and organisations. The pressure has been relentless. I single out the BMJ in particular because of its relationship to the BMA and the pharmaceutical industry. Neutral, it is not.
The BMJ is connected to a consultancy company, the CCM Group. The CCM boasts, and I reproduce it here,[vii] (Just scan read the next few paragraphs)
“CCM is pleased to be the publisher of The BMJ exclusively in Greece, Turkey and the Middle East: The official journal of the British Medical Association (BMA); Serving the medical profession since 184; Reaching key opinion-leaders worldwide; (KOL’s again) Quality, Prestige and Influence; Reaching 22,000 physicians in the Middle East; Reaching 15,000 physicians in Turkey; Reaching 15,000 physicians in Greece; Providing maximum visibility & impact for your advertising; A Portfolio of Marketing Opportunities; Full Colour Ads; B/W Ads; Product & Company News; Inserts & Reprints; Advertorials; Wrappers; Symposia; Communicate with key influence groups through the ideal advertising vehicle… with excellent value for your money; Stay ahead of the competition; Increase market share; Reinforce brand image; Control expenses; BMJ Specialist Titles (Specialist Titles are international peer-reviewed journals published by BMJ. Specialist Titles publish clinical and experimental articles pertaining to each particular disease and are committed to promoting the highest standards of scientific exchange and education. Most of these are authoritative journals in their respective fields and are the official Journals of their respective societies):
Archives of Disease in Childhood: The official journal of the Royal College of Paediatrics and Child Health is devoted to child health and disease, with emphasis on clinical paediatrics: Published monthly.
British Journal of Ophthalmology: Published monthly, the journal covers all clinical and pathological aspects in the field of Ophthalmology.
Evidence-Based Medicine: Launched in 1995 and published bi-monthly, this journal helps clinicians to base their clinical decisions on the best current scientific evidence.
Evidence-Based Mental Health: This journal is essential reading for mental-health practitioners, managers and policy makers. It uses scientific criteria to select and abstract the most reliable and important clinically relevant papers from an expanded range of journals: Published quarterly.
Evidence-Based Nursing: Designed to help nurses base their clinical decisions on the best current clinical evidence. This journal is jointly published by the Royal College of Nursing Publishing Group and BMJ Publishing Group: Published quarterly.
Gut: The official journal of the British Society of Gastroenterology. Gut is a leading international journal in gastroenterology and has an established reputation for publishing first class clinical research of the alimentary tract, the liver, biliary tree and pancreas: Published monthly.
Heart: The official journal of the British Cardiac Society covers the latest advances in the diagnosis and treatment of cardiovascular disease: Published monthly.
Journal of Neurology, Neurosurgery and Psychiatry: The Journal of Neurology, Neurosurgery, and Psychiatry publishes original articles, short reports, editorials, commentaries and more; covering the whole field of clinical neurological practice, neurosurgery & neuropsychiatry. Emphasis is given to common disorders. Focusing on clinical neurology, neurosurgery and neuropsychiatry: Published monthly.
Sexually Transmitted Infections: A long-established journal dealing with issues of sexual health, sexually transmitted diseases, HIV and AIDS. Published bi-monthly, the journal attracts original articles on the clinical, microbiological, behavioural, epidemiological, social and historical aspects of sexually transmitted diseases.
Sports Medicine: The journal covers the latest advances in clinical practice and research on all aspects of sports medicine: Published monthly.
Thorax: Thorax is one of the world’s leading respiratory medicine journals publishing clinical and experimental research articles on respiratory medicine, paediatrics, immunology, pharmacology, pathology, and surgery. Thorax is one of the highest ISI ranked journals covering all aspects of pulmonary medicine: Published monthly.
Tobacco Control: A scientific journal which considers all aspects of tobacco prevention and control: Published bi-monthly.
Evidence-Based Learning Resources: Are you looking for up to date and evidence based learning resources? Then BMJ learning is for you. It provides learning for professionals in primary care and hospital medicine and offers a range of services to support your everyday learning needs. You can:
This is a very long arm, but what of the body? CCM boasts of its clients, and in particular, pharmaceutical companies…[viii]
|3M||Egypt Otsuka Pharmaceutical Co.||Merz & Go GMBH|
|Abbott Laboratories||Egyptian Promoters Centers||Mid Pharma|
|Abdi Ibrahim||Eli Lilly and Company||Minapharm|
|Actavis||E-Merck||Mission Pharma A/S|
|African Export-Import Bank||Essex Chemie A.G.||Mustafa Nevzat|
|Aghios Savvas Hospital||Farbo Group||Nestle Nutrition|
|AkzoNobel||Ferring Pharmaceuticals||Nile Pharmaceutical Co.|
|Al Razi Pharmaceutical Co.||Gen||Nobel|
|Alcon Pharmaceuticals Ltd.||Genzyme Near East||Novartis|
|Algorithm SAL||Global Napi Pharmaceuticals||Numil|
|Al Haya Medical Company||Global Pharma||Nutricia|
|Ali Raif||Graphic International Centre||Nutridar|
|AlKamal Import Office Co.||Grunenthal GMBH||Nycomed|
|Alkan Establishment||Gulf Pharmaceutical Industries Julphar||Onko-Kocsel|
||Organon Scientific Office|
|Alpha Chem Advanced Pharmaceutical Industries||H.E. Ministry of Health||Pfizer|
|Alpharma||H2O Concepts||Pharco Pharmaceuticals|
|Altana Pharma||Habib Scientific Office||Pharma International Company|
|American Hospital||Health Technologies Limited||Pharma Vision|
|Amoun Pharmaceuticals Co.||Hikma Pharmaceuticals||Pharmaserve|
|AMP||Hoffmann La Roche||PharoPharma|
|APM||IASO Hospital||Pierre Fabre Medicament|
|Arabian Ethicals||ICN Pharmaecuticals||Polypeptide Laboratories|
|Armenia Surgical Center||IDS||Promax|
|Arrow Food Distribution||IE Ulagay-Menarini||Publicis Graphics|
|ASDA’A Public Relations||Impact BBDO||Rafarm|
|Asmedical Scientific Office||IMS Health||Ramco|
|Astellas||Innotech||Rameda Scientific Office|
|Ayoub Pharma||International Nutrition Co.||Sadco|
|Bayer Healthcare||ISO Medica||Sandoz|
|Beaufour Ipsen International||IVAX Pharmaceuticals||Sanofi Aventis|
|Becton Dickinson Diagnostics||Jamjoom Pharmaceuticals||Sanofi Pasteur|
|Bilim||Jeddah BioCity||Schering AG Pharmaceuticals|
|Biochemie||Johnson & Johnson||Shering-Plough|
|Biofarma||Jordan Pharmaceutical Manufacturing Co.||Scope|
|Biogene||Julphar Gulf Pharmaceutical Industries||Sct. Hans Hospital|
|Boehringer Ingelheim||Juva Sante||Sedico Scientific Office|
|Boston Scientific||KAT Hospital||Servier|
|Bristol Myers Squibb||Kocak||Sky High Advertising|
|Cana||Leo Pharmaceuticals||Solvay Pharmaceuticals|
|Carat||Leo Scientific Office||Spimaco|
|Central Laitiere||Lifescan, Inc.||Stiefel|
|Chemipharm Limited||Liptis Pharmaceuticals||Tabuk Pharmaceutical Manufacturing Co.|
|Ciba Vision||Magrabi Eye and Ear Center||Tamer & Co.|
|Cooper Maroc||Magrabi Hospitals & Centers||Tenzing Business Services|
|Copad Egypt Scientific Office||Marny’s C/O||The Arab Pharmaceutical Manufacturing Co.|
|Danon France||Masafat Travel & Tourism||UCB Pharmaceuticals|
|Danone||May & Baker||Unipharm|
|Dar Al Dawa||Mectapharm||United Pharmaceuticals|
|Dar Al Hikma||Media Insight Dubai||University of Ottowa|
|Delta Pharm||Medical Union Pharmaceuticals||Vichy Laboratories|
|Dem Ilac||Medtronic||Wyeth Pharmaceuticals|
|Dhahran Health Center||MENA Marketing Novalac||Zimmo Trading Est.|
|Eczacibasi||Merck Scientific Office|
|EGD||Merck Sharp & Dhome|
And just in case my US friends are feeling a bit left out, CCM Medical Publishing & Education mention: American Academy of Orthopaedic Surgeons; American College of Cardiology; American College of Chest Physicians; American College of Physicians; American Psychiatric Association; American Society of Clinical Oncology
But of course there is no pharmaceutical influence in public Health. Of course our doctors are independent of the pharmaceutical industry… And this just illustrates the reach of ONE consultancy. Have a look for yourself… https://www.groupccm.com/static/publishing
With a complex, massive international network of companies to back it up, the monstrous media machine swings into action. It has had no bigger target, ever, than the e cigarette. Misinformation is disseminated through the journals to the press and television media. It is littered with sound bites and, very rarely, if ever, is there an attempt to back up the claims being made. One KOL after another is wheeled out to give ‘substance’ to, sometimes absolute nonsense. For example: ‘Smoking’ e cigarettes might lead to cocaine addiction.
Ok, so it does not say ‘will,’ but the idea is firmly rooted in the minds of the readers. And there are many, many other examples where stupid claims are made with regard to some supposed threat presented by e cigarettes.
One is “An unexpected consequence of electronic cigarette use,[ix]” where it was claimed that e cigarette use led to a case of lipoid pneumonia. It was a ridiculous attempt at scaremongering, aided and abetted by the bias of the authors. It was subsequently ridiculed by other doctors and scientists[x] who pointed out that the authors had made elementary mistakes through gaps in their knowledge of basic school chemistry. But the damage had been done and the story, but not the rebuttals, appeared in media outlets all over the world.
Other claims are made: E cigarettes might act a gateway to young people into smoking; nicotine is dangerous; and…. Well…. E cigarettes might act a gateway to young people into smoking; nicotine is dangerous, and of course we should keep in mind that, E cigarettes might act a gateway to young people into smoking; nicotine is dangerous. This is what the opponents of e cigarettes have been reduced to, repetition after repetition of the same old rubbish: Demands that the unprovable be proven – over and over again. This is the strategy of the manipulator, say something often enough and loud enough and it will be accepted.
There is one other claim, one that leads to my reason for the title and one which provides more evidence of psychological manipulation, and that is that e cigarette vapour endangers the health of others. At this point I will remind you of the caveat to the definition of positive psychological manipulation, is that it should not be, “unduly coercive.” I am afraid to say that in the area of second and third hand nicotine exposure… it is.
Nothing upsets and angers the general public more than the thought that they are being poisoned by these ‘dirty smokers.’ E cigarette users are being classed as ‘dirty smokers’ as well due to the manipulations of Pharma and its powerhouses. I need present no evidence for this as it is self-evident in the attitude of the public towards second hand vapour and smoke. It is self-evident in the arguments of those proscribing bans in public places. It litters academic literature. The demand is ever present for smokers and vapers to be ostracised and hidden away from the rest of society. The demand is always there for one man to hate his neighbour and this is created, aided and abetted right from the top down straight into your doctor’s surgery, and, via the newspaper, it lies in wait, on the floor, under the letter box of the house next door, just needing to be picked up and read.