Behavioral Economics Aren't that Convincing in Medicine

  • 🎬 Video
  • ℹ️ Published 4 years ago

There have been a lot of stories about using behavioral economics to change wide array of human behaviors. Studies have looked at adherence to treatments, weight control, and lots of other areas, and have found that trying to change people with economics isn't all that effective.

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John Green -- Executive Producer
Stan Muller -- Director, Producer
Aaron Carroll -- Writer
Mark Olsen – Graphics
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💬 Comments

One thing I've learned in pharmacy school is that patients are more likely to be compliant if you simply go to the trouble of counseling them on potential side effects and what to do if they experience them. Patients are more likely to continue a medication in the face of a side effect if they were prepared for it, whereas if it catches them by surprise, they are more likely to stop completely.

I've seen this play out in real life. My father-in-law was prescribed a medication, one which his health history makes him a good candidate for. He got a well-known side effect, one that can be easily dealt with by a simple change in therapy. But nobody ever told him about it ahead of time. He wound up turning to Dr. Google to try to figure out what was wrong and decided on his own to discontinue his medication without talking to his doctor about it first, and since then he has refused any similar medication despite his doctor's recommendations. He has his mind completely set against this particular drug therapy now, one which he really ought to be on, all because nobody ever told him ahead of time what might happen and what to do about it if it did.

Author — thatjillgirl


I really think we need to know why people aren't compliant, because it's going to be different for everyone. Side effects? Not seeing the effects? Can't afford it? Forgetful? Just don't care?
All these reasons would require different approaches. I think there's something wrong on a base level when you can't use the draw of free money to get people to comply.

Author — Medical Meccanica


This is a misuse of the term behaviour economics. What you've shown is that some specific economic experiments meant to incentivise certain behaviours didn't work as hoped. Fair enough, but this does not speak to the general efficacy of BE in medicine. It's the equivalent of saying that because some drug trails failed to show that some specific medicines didn't relieve symptoms, pharmaceuticals aren't that convincing in medicine. It's too new a field to draw such broad conclusions.

Author — slimwillywilliams


He is referring to the Heartstrong RCT. It was a terrible study and should not be taken as representative of behavioral economics. The researchers sent instructions and equipment and reported NO effort to check intervention integrity. Behavioral economics depends ENTIRELY on people engaging in prescribed behavior. The problem was not behavioral economics, the problem was poor implementation.

Author — Ninjasaurus Rexatron


The theory of people being largely rational actors is really taking a beating lately.

Author — yanipheonu


I wonder if we shouldn't be focusing more on why people are non-compliant first. I don't take anything that isn't OTC, but I occasionally forget to take my pills anyway, despite having done about as much as I can to make sure I don't.

Author — Take Walker


Aaron Carroll, you rock! I've been reading health news for decades, at this point, and your analysis is the most clear-sighted I've seen--independent-minded but grounded in science. I'm especially struck by how much MORE information I have derived from your videos vs your NY Times columns because of the difference between the (lively) spoken word and the (dead) written word. When you are so emphatic about certain points, it gets my attention... I hope you get many more viewers. Publicize, publicize, PUBLICIZE!

Author — David L.


Another problem is that we don't actually know what prevents different people from compliying. So we're not coming up with the support targeted to where the person needs it.

Author — Judith Montel


We need a really angelic person to convince people to take their medication. There’s been too many people who have taught, but have been hypocritical behind closed doors, thus karma wins.

Author — THE JACK HQ


Is healthcare triage live still going, or did you morph that into the podcast? Either way keep up the good work! :)

Author — NightNoon


Yes. Let's blame patients. Not clinics that make it difficult to renew prescriptions and use them as a leash to force unnecessary return visits. Not insurance companies that won't give you more than 30 days of a drug at a time even when prescriptions are written for longer periods. Don't blame the insurers who charge arbitrarily high prices for some drugs and not others requiring the patient to wait for unnecessary prescription changes. Don't blame the pharmacies that intentionally fill the prescriptions slower so that you will stay in the store longer or their pharmacists who incessantly question every doctor's order and slow everytihng down. This is all clearly the patient's fault. When drugs are available people will take them. The issue is that we have put a bureaucratic system in control of the patient rather than put the patient in control of their own health.

Author — Eric Rini


Want people to take their medications? Electronic pill bottles won't work. The easiest way to do is by getting them to buy and use a pill calendar. People are often afraid of missing or doubling doses, and pill calendars helps with that. They also tell you when you miss doses and how often, which will get you to be responsible for your own health.

Author — Educational YouTube


these sorts of programs will take time to bare fruit. its not just about influencing individuals but the attitude needs to change in communities as well.

it may just take a very expensive propaganda campaign like the USA does during wartime, except in this case healthy habits will be the focus.

Author — Humpy Mcsaddles


Side effects! Tons of drugs where side effects at the therapeutic dose are not tolerable or the drug is ineffective or actually aggravates the condition. These drugs are tested on average people—dosing is not adjusted for genetics, liver enzyme profiles, or personal biochemistry. Doctors take a one-sized fits all approach and then blame the patient for noncompliance. Better medicine and treatment leads to better compliance.

Author — DarkBlue Matter


What about the DOTS protocol to ensure medication adherence of TB patients? Could you please look into that?

Author — Saumitra Chakravarty


I've never not filled a script for a reason other than not being able to afford to.

Author — turdl38


Your the best thank you for All your amazing videos

Author — Lana Banana


Started reading one of Richard Thaler's books last week, funny timing!

Author — gillianemb


+Healthcare Triage

Why would a "rational" person not submit to a course of care prescribed by his/her superior when his doctor has given him/her both the costs and benefits of both compliance and non-compliance?

Analyze the above statement, and you will understand why this is the case, at least enough times to be worrying.

The trouble is that these courses of treatment offer the patient no immediate, tangible benefit, and by not submitting to treatment, the patient is not offered and immediate tangible risk. You are counting on citizens doing mathematics which is well above their level of competence - in essence you are demanding that they trust their doctor, even if their doctor is not even competent in the math required to balance his/her chequebook.

What happens if the patient follows the prescribed regimen? Does he/she feel any better? For the most part, no! Is he annoyed at being "forced" to "take his medicine"? For the most part, yes! Partly because he/she has to do something that he/she did not have to do before, but MAINLY because it is a remindrance of his/her weakness.

What happens if the patient goes off of the prescribed regimen? Does he/she feel any worse? For the most part, no! But he/she does not have to take those damn pills. (I know of what I speak. My wife has MS. She was prescribed Copaxine injections. Over time, she could not see any benefit. The injections did not make her feel better, and she still had MS attacks. You could show her that the rate of attacks had slowed, but in her mind, that was not significant. She finally stopped. Did she go into a wheelchair immediately? No! As far as she could see, there was no difference between taking the drug and not taking the drug. You could show her the statistics, but her eyes would glaze over, much like your (and my) eyes would glaze over if someone endeavoured to explain the math behind string theory. Here you have a classic case of the costs and benefits are only accessible to the doctor, not the patient.)

Would you like a suggestion? Those long term drugs that you want the patient to stay on? Combine them with oxytocin. At least your patient would get an immediate boost from taking it.

Author — David MacLean


Lol, they picked some of the least effective mechanisms. The only really effective mechanism in the batch was the optional one

Author — Kristopher Donnelly