We can understand the mass consumption of sterilization products like bleach or hand sanitizer clearing shelves at convenience stores and supermarkets during the pandemic. However, the underlying motive for panic buying toilet paper is a bit harder to fathom.
Why would the public stockpile toilet paper during a pandemic that primarily affects the respiratory system, not the large bowel? Let’s face it, you can’t eat, drink, or use toilet paper to fuel your car or heat your home. It’s a single-purpose product (especially if it’s single-ply!) and it’s not in short supply like ventilators or N95 respirators, yet people were fighting each other for it.
Fortunately, we can turn to interrelated research in economics, psychology, and marketing to explain this seemingly non-sensical panic purchasing. The primary culprit is a cultural phenomenon that researchers refer to as the bandwagon effect (also called the contagion effect).
The bandwagon effect explains the propensity to adopt a particular viewpoint or do something primarily because a majority of other people are doing it, even if the individual does not understand or agree with the action.(1) Hence, this phenomenon holds regardless of whether the behavior is seemingly rational at the time (mass purchasing hand sanitizer) or irritational and illogical (mass purchasing toilet paper).
We can use the metaphor of a virus rapidly multiplying to describe how contagious behavior is spread via the bandwagon effect.
There typically are numerous explanations for what prompts a viral spread of behavior. In the case above, the media is partly responsible for exacerbating toilet paper panic buying. If fewer newspaper articles were published on possible toilet paper shortages and cable news reporters had not spotlighted panic buying, then there would not have been a toilet paper crisis. Once the public had the impression (sparked by media sensationalism) that the next time they needed toilet paper there wouldn’t be any available, everyone suddenly rushed to supermarkets to panic buy the product. Consequently, it becomes a self-fulfilling prophecy when precautions to avoid running out of something causes a run on the product, leading to shortages.
Panic buying is often precipitated by negative feelings (e.g., uncertainty, anxiety, fear, diminished trust, perceived risk, etc.) which trigger specific social behaviors related to group conformity to instinctively protect oneself, provide a sense of coping with the crisis, or a means of maintaining control.(2)
The bandwagon effect is so powerful that its impact has been observed in politics, public policy, advertising, marketing, and even healthcare. For example, studies have found that the bandwagon effect can influence undecided voters to cast their ballots for the person expected to win.(3) Research has also shown that the bandwagon effect influences consumer trust and willingness to use a product or pay a price premium.(4)
Moreover, when it comes to our health, patients often “jump on the bandwagon” of what others are doing or recommending, while healthcare providers themselves tend to follow an imitation strategy, looking to their competitors and industry exemplars for healthcare management solutions.(5)
GROUP CONFORMITY
Group conformity occurs when we change our opinion or behavior to match a group’s opinion or behavior.(6) During the early 1950s, psychologist Solomon Asch sought to determine the extent to which social pressure from a group could cause individuals to conform to majority rule. In what is now known as the Asch Phenomenon, researchers ran a series of laboratory experiments investigating whether participants’ judgments on a simple visual perception task could be affected by group pressure.(7)
Briefly, in these classic experiments, a researcher would tell a group consisting of several confederates (i.e., actors who were aware of the real aim of the experiment) and one unsuspecting test subject that they would be taking part in a line judgment task to measure their visual perceptions. Notably, the experiment was designed so that the correct answer was simple and obvious.
The researcher would then reveal one card depicting a vertical line segment labeled as “Figure I” and a second card displaying three line segments of varying lengths each labeled as “A,” “B,” or “C.” The group was asked to determine which of the three line segments was the same length as that of “Figure I.”
The confederates had previously been instructed regarding which incorrect responses they should select, while the actual test subject was unaware of this deception and led to believe that the confederates were also real participants.
At first, when the researcher asked each person to choose which of the three line segments matched the length of “Figure I,” the confederates all selected the same incorrect answer while only the test subject selected the correct answer.
The task was repeated several times with different cards, and it was clear to the test subject that the others were wrong, yet they all gave the same incorrect answer. Therefore, the test subject had to decide whether to 1) provide the correct answer but stand out from the group, or 2) conform to the group even though they were making mistakes to avoid the discomfort of being the only dissenting member.
This demonstrates the bandwagon effect: If a test subject gave an incorrect answer despite knowing it was wrong, it would be clear that this was because of social pressure and group conformity. The results of the Asch experiments revealed that a significant percentage of participants (74%) conformed to the incorrect group consensus, even when the correct answer was obvious.(8) This explains the powerful influence of social pressure and the tendency to conform to majority rule, even when it contradicted one’s own perceptions, opinions, and beliefs.
If we extend our understanding of group conformity to more practical real-world examples, there are several contemporary instances of the bandwagon effect in modern society. These include:
Fashion Trends: People adopt popular styles or trends to fit in or be perceived as “fashionable,” such as buying trendy jeans with holes in the knees at nearly twice the price of conventional jeans.
Product Adoption: Consumers are more likely to buy products or services that have gained mass popularity and received a higher number of positive reviews. Examples include smartphones, fitness trackers, anti-aging skincare serums, etc.
Social Media: On platforms like TikTok or Instagram, users follow popular influencers or engage in trending content simply because “everyone else is doing it.” For example, social media crazes that have gone “viral” include the ALS Ice Bucket Challenge, the Griddy dance, and Livvy Dunne.
Political Campaigns: When a candidate gains momentum or starts to lead in polls, some voters may feel more inclined to support them because they think other voters are doing the same. Some examples are politicians such as Alexandria Ocasio-Cortez, Ron DeSantis, Bernie Sanders, Pete Buttigieg, etc.
Investment Frenzies: In the stock market, individuals may start buying certain stocks simply because their prices are rising without necessarily considering the underlying fundamentals. For instance, consider the Bitcoin bubble, NFTs, and GameStop stock short squeeze, and the FTX collapse.
These represent just a few cases of the bandwagon effect across various domains. By considering the wide spectrum of effects, it is possible to see how this phenomenon is rooted in the human tendency to seek safety and protection in numbers by conforming to group norms and gaining social acceptance.
THE BANDWAGON EFFECT IN HEALTHCARE
Group conformity is a powerful force guiding human behavior, yet this type of social pressure can influence our decisions in ways that may help or hurt us: “Positive bandwagons might inspire us to adopt healthy behaviors, while negative bandwagons might lead us to try out questionable health advice or spend money on things we don’t need.”(9) The following represent complex considerations for how the bandwagon effect may impact our patients, physicians, and the practice.
Diets and Weight Loss Programs. Many types of fad diets have risen to popularity over the years, some with more substantiated health benefits than others (e.g., keto diet, paleo diet, veganism, intermittent fasting, high-protein diet, South Beach diet, Atkins diet, etc.). When everyone appears to adopt a particular diet, people become more likely to try it for themselves, often without consulting their physician for advice on whether that diet is healthy or right for their wellness needs.
Many opt for rapid weight loss diets to achieve immediate results; however, these often prove to be unsustainable over time. The prevailing nutritional advice would be to adhere to a more balanced diet that gradually reduces potentially problematic nutritional elements (carbohydrates, saturated fats, etc.), rather than eliminating these entirely (cutting out carbohydrates) in favor of meals that are imbalanced in other directions (higher fat intake).
Pro: Patients attempting to build healthy eating habits and meet weight loss goals.
Con: Patients falling victim to unhealthy and unsustainable diets lacking in nutrition.
Exercise and Fitness Programs. Similarly, several popular exercise regimens have gained considerable attention for their quick results, yet typically lead to deleterious effects over time. For example, practices such as Beach Body, P90X, hot yoga, CrossFit, and others create a sense of dissatisfaction with the individual’s physical condition and encourage them to “get healthy” through drastic physical exertion changes.
While promoting increased physical activity is an important goal for the average person, a risk of many fad fitness programs is that they often advocate extreme exercise regimens that are unrealistic, unsustainable, and put high levels of stress on the body without a gradual build-up to properly prepare the body for higher levels of exertion and physical activity.
Pro: Patients seeking to engage in healthier lifestyles that are more physically active.
Con: Patients having unrealistic weight/physique/strength goals in high-stress conditions.
Pharmaceutical Ads and Prescription Requests. Patients may visit the doctor to request a prescription that “their friend told them about” or they saw on a television ad for a condition that they believe was similar to their own self-diagnosed medical problem (e.g., ADHD medications such as Adderall or Ritalin, diabetes medications like Ozempic with off-label uses for weight loss, etc.).
It may require a long and difficult discussion with patients to convince them that the medication is inappropriate for their needs, often resulting in a patient going to another practice to receive the medication that they want.
For example, the use of Semaglutide or Ozempic has significant side effects and drug-drug interactions. Thus, the drug should only be used under the advice and care of a physician, not fueled by the bandwagon effect of what is sensationalized in the media. Unfortunately, some physicians may get on the bandwagon and acquiesce to the patients’ request, providing them with a prescription for the medication.
Pro: Patients being proactive about their health and more likely to follow treatment plans.
Con: Patients taking medication that they may not need or may use for non-prescribed purposes.
Medical Decisions. Some medical treatments and procedures have been widely practiced for decades, despite a lack of sufficient supporting evidence for their efficacy because they were considered popular by the medical community based on minimal anecdotal evidence. One of the best examples is bloodletting, which was a method of treating a variety of disease states that goes back nearly 3,000 years to the Egyptians, was continued by the Greeks and Romans, then the Arabs and Asians, and finally spread through Europe during the Middle Ages and Renaissance periods. In fact, bloodletting was even used on President George Washington, who presented to his physician with a fever and respiratory distress before having copious amounts of blood drawn and ultimately dying of epiglottitis and shock.
A more modern (and less drastic) example might be non-FDA-approved IV vitamin infusion therapy as a wellness trend claiming to have many health benefits.
Pro: Physicians adopting treatments or procedures with outward community support.
Con: Physicians prematurely using treatments and overlooking evidence-based medicine.
THE BOTTOM LINE
The bandwagon effect is not necessarily a negative phenomenon. Group conformity can be constructive and used to the advantage of the patient and the practice, but only when used responsibly.
One of the authors, Neil Baum, has a positive example from his own practice that demonstrates the potential prosocial benefits of the bandwagon effect. When he began his practice more than 40 years ago, he started saving letters from patients complimenting him and his staff on how much the patients appreciated their care.
In some practices these types of letters may end up thrown in wastepaper baskets, filed in desk drawers, or hopefully posted on the walls of the employee lounge to share with the entire staff. However, after receiving about a dozen lovely notes and receiving permission from their authors, Baum placed them in a scrapbook and put them on display in the reception area. He labeled the scrapbook “Doctor Baum’s Warm Fuzzy Book” (see Figure 1).
Figure 1. Doctor Baum’s Warm Fuzzy Book
The book was the most-viewed item in the reception area. Patients often asked, “How can I get in the book?” Baum told them that all they had to do was write him a letter. As a result, he received several hundred responses over the years and placed each of them in scrapbooks in the reception area. There are now more than 15 scrapbooks that contain these positive notes.
With just a few initial letters, a beneficial bandwagon effect produced accolades from previous patients who shared their positive experiences with his practice, as well as heartwarming stories to lift the spirits of the other patients.
Ultimately, when it comes to harnessing the power of group conformity, using it to create a Warm Fuzzy Book is a far better action than inspiring the panic buying of toilet paper.
REFERENCES
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Neumann KD, Temple J. The Psychology of Panic Buying. Forbes. January 27, 2023. https://www.forbes.com/health/mind/panic-buying/
Liu Y, Ye C, Sun J, Jiang Y, Wang H. Modeling Undecided Voters To Forecast Elections: From Bandwagon Behavior and the Spiral of Silence Perspective. International Journal of Forecasting. 2021;37(2):461–483. https://doi.org/10.1016/j.ijforecast.2020.06.011
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Asch SE. Effects of Group Pressure upon the Modification and Distortion of Judgments. In H. Guetzkow (ed.), Groups, Leadership, and Men. Boston: Houghton Mifflin; 1951.
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