Dangers of conformity in medicine

Dear Friend,

Hope you all are having a lovely bank holiday weekend. I’m delighted that so many people have signed up to attend my upcoming book launch on May 23rd – there are only a few spots left, so if you are free that evening and able to attend would be great to have you there. Plus enjoy some free food and get to pitch your own ideas to a publisher. You can sign up here. 

This week, I finished my on-call block of acute medicine and started working on a new ward (rheumatology). I was very apprehensive before joining this ward, as a few people who had worked there previously had not had the best experiences. This included stories such as consistently leaving late, excessive workload, unfriendly staff and patients etc. When others would ask me about this ward, I would also share similar views – despite the fact that I had never worked on this ward. However, I was quite surprised to find that my experience this week was quite the opposite. In fact, it was one of my best weeks in medicine so far. 

Seeing how other people’s negative views had influenced my own judgements reminded me of the Asch conformity study, by conducted by psychologist Solomon Asch in the 1950s, which shed light on the profound impact social pressure can have on individual judgment.

Therefore, this week, I’d like to share with you the principles of this study and the power that other people’s views have on our own perception

The Asch Conformity Study

Asch (1951) conducted one of the most famous laboratory experiments examining conformity. He wanted to examine the extent to which social pressure from a majority, could affect a person to conform.

Asch’s sample consisted of 50 male students from Swarthmore College in America, who believed they were taking part in a vision test. Asch used a line judgement task, where he placed a participant in a room with seven actors, who had agreed their answers in advance. The real participant was led to believe that the other seven people were also real participants. The real participant always answered second to last, so they would hear the responses of the actors before. 

Each participant completed 18 trials and the actors always gave the same incorrect answer on 12 trials, called critical trials. Asch wanted to see if the real participant would conform to the majority view, even when the answer was clearly incorrect.

Asch measured the number of times each participant conformed to the majority view. On average, the real participants conformed to the incorrect answers on 32% of the critical trials. 74% of the participants conformed to the incorrect answer on at least one critical trial. Asch also used a control group, in which one real participant completed the same experiment without any actors in the room. In this control situation, the participant gave an incorrect answer less than 1% of the time. 

Asch interviewed his participants after the experiment to find out why they conformed. Most of the participants said that they knew their answers were incorrect, but they went along with the group in order to fit in, or because they thought they would be ridiculed. This confirms that participants conformed due to social influence and the desire to fit in.

The Asch Conformity Study serves as a poignant reminder of the susceptibility of human judgment to external influences. In our daily lives, we often encounter situations where the opinions and actions of those around us exert a profound impact on our own perceptions and decisions. Whether it be in the workplace, social settings, or even within the medical field, the pressure to conform can be palpable.

Summary

This experiment shows how those around us really have the ability to influence our own thoughts due to our desire to fit in. When confronted with a problem, doing it the way everyone else does it doesn’t necessarily mean that it is the best or only way to do it. Sometimes, it’s better to trust your own instinct.

I’ll be keeping this lesson in mind in my future encounters as a junior doctor. Hope you also found it an interesting read. 

See you next week!

Drug of the week

Natalizumab

This is a monoclonal antibody which is directed against the molecule a4-integrin. 

It is used to treat autoimmune conditions like multiple sclerosis and Crohns disease

It targets a protein called α4β1 integrin on white blood cells involved in inflammation.

By attaching to integrin, natalizumab is thought to stop white blood cells from entering the brain and spinal cord tissue, thereby reducing inflammation and the resulting nerve damage.

It is associated with an increased risk of developing progressive multifocal leukoencephalopathy, a viral infection of the brain caused by reactivation of the JC virus due to immunosuppression. 

A Brain Teaser

A 70-year-old woman is brought to A&E following a collapse at home. Her past medical history includes; COPD, recurrent urinary tract infections, hypertension and hypercholesterolaemia.

She recently attended her general practitioner with a chest infection and was started on a week-long course of antibiotics as well as several medications for symptom control. She has also commenced several new medications for recently diagnosed hypertension.

Her examination is unremarkable. A twelve lead ECG is performed which shows normal sinus rhythm, however, her QTc is noted to be markedly prolonged at 590ms.

Which of the following medications is most likely to have caused this ECG abnormality?

A: Clarithromycin

B: Cyclizine

C: Doxycyline

D: Lercanidipine

E: Rosuvstatin