Weaponizing Hope: Sources of Hope, Unrealistic Optimism, and Denial.
Weaponizing Hope: Sources of Hope, Unrealistic Optimism, and Denial.
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将希望武器化：希望的来源、不切实际的乐观主义和否认。
DOI：
10.1080/15265161.2018.1498946
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发表时间：
2018
期刊：
影响因子：
--
通讯作者：
Master,Zubin
中科院分区：
文献类型：
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作者：
Michie,Marsha;Allyse,Megan;Stoll,KatieA;Master,Zubin
医疗护理中的希望、不切实际的乐观和否认从何而来？虽然Blumenthal-Barby和Ubel（2018）的目标文章恰当地解决了患者潜在不准确信念的可能影响，但它没有讨论这些信念可能来源的外部来源。作者提供了许多临床实例，其中向患者提供的信息是真实的，并且以无偏见和无价值的方式提供。在这种情况下，来源可能没有什么区别，但在其他情况下，特别是在商业实体销售的诊断或干预措施的情况下，患者的信念及其后果可能会受到利润动机的严重扭曲，其主要受益者既不是患者也不是更大的卫生系统。在这种情况下，现实的希望和不切实际的乐观之间的界限需要医疗服务提供者更加仔细地关注，他们的职责是促进明智的决策，包括积极抵制营利性诊所、实验室甚至医生的信息，对商业技术的不切实际的信念最常见的来源是直接广告，无论是对患者还是对提供者。药品、基因检测和营利性诊所的广告充斥着电视广播，互联网上的目标客户，以及胡椒行业的出版物和会议。虽然联邦通信委员会可能会打击公然的违法行为，但精明的营销人员通常会将科学诚信的暗示，模糊但充满希望的承诺和视觉吸引力结合起来，以产生乐观和欲望的感觉。例如，商业基因实验室直接面向消费者的营销往往不太依赖可靠的临床效益证据，而更多地依赖于对自我认识价值或父母对未来子女的遗传责任的情感诉求。提供者出售未经批准的干细胞治疗往往提供轶事，甚至完全捏造的证据，有利于病人绝望的希望。不管是什么信息，几十年的营销研究表明，投资重复性广告会带来巨大的回报，
Where do hope, unrealistic optimism, and denial in medical care come from? While the target article by Blumenthal-Barby and Ubel (2018) aptly addresses possible implications of patients' potentially inaccurate beliefs, it fails to discuss the external sources from which these beliefs may derive. The authors provide numerous clinical examples in which the information provided to patients is factual and delivered in an unbiased and value-free manner. In such cases, the source may make little difference, but in others-particularly in the case of diagnostics or interventions that are marketed by commercial entities-patients' beliefs and their consequences may be skewed significantly by profit motives whose primary beneficiary is neither the patient nor the larger health system. In such cases, the problematic line between realistic hope and unrealistic optimism needs more careful attention from medical providers, whose duties to facilitate informed decisions may include actively countering messaging from for-profit clinics, labs, and even physicians.The most familiar source of unrealistic beliefs about commercial technologies is direct advertising, whether to patients or to providers. Advertisements for pharmaceuticals, genetic tests, and for-profit clinics flood the airwaves, target customers on the Internet, and pepper industry publications and conferences. While the Federal Communications Commission may crack down on blatant offenses, savvy marketers typically combine hints of scientific integrity, vague yet hopeful promises, and visual appeal to produce feelings of optimism and desire. Direct-to-consumer marketing by commercial genetic labs, for example, often relies less on reliable evidence of clinical benefit and more on emotional appeals to the value of self-knowledge or parents' genetic responsibilities to their future children. Providers selling unapproved stem-cell treatments often provide anecdotal or even completely fabricated evidence of benefit to patients desperate for hope. And whatever the message, decades of marketing research have shown that investing in repetitive advertising pays huge dividends in