ENG I DEU
In all topics related to medicine, expert interviews are extremely valuable to understand the complexly linked decisions that decide about the fate of medicines and medical devices in the market. The value of interview findings depends mainly on the reliability of the expert statements. The main threats to trustworthy outcomes are not outright false statements, but those tweaks and twists of truth to please the interviewer that are commonly known as “white lies”. While there is no way to prevent them completely, there are ways to minimise their impact.
Some time ago, I accompanied a doctor to his taxi after a lecture he had given to pharmaceutical sales representatives (sales reps). He had conducted a nice study on a multimodal approach to improve patient outcomes after surgery. One intervention included a generic drug the sales reps were promoting, so the marketing director and I had found it worthwhile to invite him. We wanted to demonstrate to the sales reps that generic drugs play an important and even increasing role in clinical practice if they are used according to modern concepts. The doctor had well understood that his audience would not so much need a scientific demonstration but a motivational push. And their lively discussion with him after his lecture proved that he had succeeded. However, when we went to the car, he told me: “You know, generics are a very good thing, but the drug that is so important to your customer is just a minor commodity, and we doctors do not care who delivers it to us.” I was a little taken aback by his comment because a few minutes ago he had made the audience feel that they made an important contribution to his work by selling him their product. In fact, he had told them a white lie.
White lies aim to please others without immediate benefit to the liar, but they may provide a reward in the long run. They are a social lubricant and are in fact required for an agreeable social environment. Just imagine your colleague mentioning that she just received her pilot’s licence and you, following your strict ethics of never lying to anyone, tell her that you consider it a waste of money and an unacceptable risk to fly a sports plane. Other colleagues watching the two of you would surely think you are unkind, and it is extremely unlikely that anyone would commend you on your strong ethic values. However, besides their positive social function, white lies may have unwanted effects if you want to find out what the real attitude of a person is, e.g. in an expert interview. A white lie can distort exactly what you have set out to discover with your interviews, because compared to surveys, qualified interviews with high level experts cannot be conducted with large numbers of people to level out such bias.
To safeguard your deductions from interviews against white lies, it is important to understand that many of them are made by the interviewees without thinking much about them. Your interview partner may only deviate gradually from reality, so the lies do not run substantially against her or his moral beliefs and perceived truth and thus do not cause relevant psychological discomfort.1 Therefore, measures to deter outright lies like face to face interviews and appeals to the ethical values of the interviewee are unlikely to prevent white lies.
That’s why it is important to understand why white lies are told:
1. The interviewee may perceive a need to please the interviewer, who may have provided compensation for the interview or out of general loyalty to the brand or company which commissioned it.
2. They may be used to cover-up perceived deficiencies, e.g. by opinion leaders who lack current knowledge about day-to-day practice on the ward. This may e.g. result in outdated information about procedural methods.
3. Professional affiliation to the interviewer may result in white lies to prevent perceived exposure. For example, a doctor asked about his drug usage according to guideline recommendations, may tend to give an answer that does not expose a deviation from them when the interviewer is a doctor her- or himself.
4. White lies may be triggered by the way a question is posed. It does not have to be an outright suggestive question like “You surely prefer Wonderdrug?”, even a seemingly neutral question like “Do you consider Wonderdrug effective?” will receive a positive answer disproportionately often because we all have a tendency to give a positive feedback to a positively formulated question.2
Another trigger of white lies is a cultural background from societies that value interdependence higher than independence.3 However, according to my experience from interviews in an environment of high-status, highly educated individuals, this aspect may not exert a substantial influence on their answer behaviour. Most of these interview partners have reached their position because of independent thinking, and this becomes quite obvious when you talk to them.
With the basic risk of white lies in mind, there are some approaches to reduce their influence on the outcomes of expert interviews:
1. Whenever possible, also choose interview partners yourself and do not rely exclusively on names given by your customer. For many topics, it is a good start to scan the literature for experts who have published on the topic you’re researching. Focus on authors without key opinion leader status, unless you are looking for “political” intelligence.
2. Discuss with your customer if it is necessary to have a company representative join the interview, be it via phone or in person. Their presence is quite likely to substantially influence the information provided by the interviewee. An interviewer that is perceived as uncommitted is more likely to receive an open evaluation of competing companies.
3. Formulate the briefing for the interviewee in a way that does not point her or him into a certain direction, e.g. by using marketing phrases.
4. When drafting the questionnaire, you may already be aware which questions may trigger white lies. It may be worth to approach the topic from a different angle to verify statements. For example, if you ask about the implementation of a guideline recommendation at the interviewees’ institution, you may later ask how she or he would treat a patient with medical parameters that make him applicable for guideline-based treatment.
5. Experts are always more open if they perceive the interviewer as competent and well prepared for the interview. But this can trigger white lies due to affiliation or the will to please. If you can give information during the interview that is further digging into a topic or new to her or him, you may create an atmosphere of professional trust that enhances balanced responses.
6. Verbal cues are more reliable than visual cues to identify deception.4 Interviews via phone let you focus on verbal aspects. If the interviewee is fine with it, record the interview. This will allow you to listen to statements that may be white lies again and identify potential clues. It will also help you to identify your own misunderstandings or misperceptions in your minutes, which may be considered white lies to yourself.
Notwithstanding the risk of white lies, expert interviews are one of the quickest and most rewarding means to get information about a wide range of topics. They are especially well suited to track down topics that are difficult to quantify, e.g. attitude towards treatments, unmet medical needs or upcoming developments. A handful of simple precautions will guard you against an unintended bias in your results and help you to provide relevant and reliable information for your customer.
1. Hilbig BE, Hessler CM. What lies beneath: How the distance between truth and lie drives dishonesty. J Experim Social Psych 2013; 49(2): 263-266
2. Steinmetz J, Posten AC. White lies and black lies: What they have in common and how they differ. The inquisitive mind 2018 at White lies and black lies: What they have in common and how they differ (last accessed 07/2019)
3. Fernández I, Paez D, González JL. Independent and Interdependent Self-construals and Socio-cultural Factors in 29 Nations. Intl Rev Social Psychol 2005; 18(1): 35-63
4. Bond CF, De Paulo BM. Accuracy of deception judgments. Personality Social Psychol Rev 2006; 10(3): 214–234