Latest Blog Posts & Articles


Why Don’t Americans Trust Doctors?

Politics & HealthcareIt is an oft recited paradox that Americans like the men or women representing them in Congress, while hating Congress as a whole. In fact, respect for Congress is near all-time lows. In what has to be seen as a bad sign for the medical profession, people’s attitudes towards physicians are beginning to look downright Congressional.

Most Americans like their doctors, with surveys showing that the majority report being completely or very satisfied with the medical treatment they received at their most recent doctor appointment. That satisfaction, in fact, puts the U.S. in 3rd place out of 29 countries surveyed, for satisfaction with medical care trailing only to Switzerland and Denmark. (In our defense, those countries have very satisfying doctors!)

However, in the same survey where people were asked whether “all things considered, doctors in the U.S. can be trusted,” Americans showed much more concern than citizens of most other countries, tying us for 24th overall. We were trailed only by Chile, Bulgaria, Russia, and Poland. In short, Americans love their doctors, but aren’t so fond of the medical profession as a whole. (To read the rest of this article and leave comments, please visit Forbes.)

Posted in Health Policy, Medical Decision Making | Tagged

Wonderful Review of Critical Decisions in Hastings Center Report

Critical DecisionsI’m not sure why I didn’t notice this earlier, but I just came across a very gracious, even overly generous, review of my book, Critical Decisions in the leading journal of bioethics, The Hastings Center Report. I thought I would share it with you:

When I finally got eyeglasses as a teenager, after denying the need for far too long, I was repeatedly surprised by the world that everyone else had been seeing all along. Leaves on the trees, graffiti by the highway—I was astonished, amazed, and suddenly informed. It is easy to assume we are seeing all we need to see, knowing all we need to know, until something jars us from this false comfort and compels us to reconsider. So it is with thinking about the current state of doctor-patient decisions. The unfocused view has physicians listening to patients and clearly communicating information about illnesses and treatment options, patients making good use of high-quality data to craft sound decisions, and doctors joining patient preference with provider beneficence to optimize decisions. The reassuring outlook finds physician paternalism defeated, patients empowered, and all right with the world.

Peter Ubel cannot let that fiction stand. In Critical Decisions: How You and Your Doctor Can Make the Right Medical Choices Together, Ubel reminds us that our work in actualizing patient autonomy and fostering patient participation in critical health decisions remains far from over.

As suggested by its subtitle, Critical Decisions is a book written for patients, though its value for physicians, bioethicists, educators, and students should not be underestimated. Deftly drawing upon his expertise as a physician, ethicist, and behavioral scientist, Ubel aims to improve the quality of health care decisions by arming his readers with vital intelligence.

To read the rest of the review, please visit The Hastings Center Report.

Posted in Critical Decisions, Health & Well-being, Health Policy, Medical Decision Making

How Healthy Food Could Make You Fat

Overweight SaladHave you ever eaten a healthy meal, maybe some brown rice and stir-fried veggies, and found yourself ready for another meal just a short while later? Or, more often couldn’t overcome a hankering for a satisfying dessert to top off (and undermine the healthiness of) that meal?

As it turns out, this lack of satiety is not merely a function of the lack of calories in your entrée, but also reflects an unconscious connection between your perceptions of how healthy the meal is, and your hormonal response to said meal. That’s the bottom line of research conducted by Alia Crum, a researcher at Stanford University.

Crum presented people with vanilla milkshakes and convinced some people the shake was a no-fat, low-sugar health drink and others that it had enough sugar and fat to feed a large family. (Okay; slightly exaggerating.) She discovered that people eating the “healthy” milkshake (which, of course, was identical to the unhealthy one) experienced an elevation of a hormone called ghrelin, which slows metabolism and stimulates appetite. Those believing that the shake was unhealthy, on the other hand, experienced a drop in ghrelin, and thus were more satisfied.

Think about what this means for dieters. They eat healthy meals in hopes of losing weight and their damn bodies fight back, hoarding on to the calories they’ve consumed while, simultaneously, telling them they need to consume even more calories. (To read the rest of this article and leave comments, please visit Forbes.)

Posted in Behavioral Economics and Public Policy, Health & Well-being | Tagged ,

Follow-Up on My Stoplight Musings

Stoplight Labeling UKRecently, I posed some thoughts about why the stoplight warning symbols about to be used for food products in United Kingdom might be misleading. A blogger at BigThink.com picked up on my train of thought. Here is her piece:

Color-Coded Nutrition Facts May Confuse Rather Than Inform Consumers
by Natalie Shoemaker

The obesity epidemic is well-known and countries are trying to do what they can to fight it. Peter Ubel of Forbes highlights a UK food labeling system that hopes to teach consumers to make healthier choices through color-coded labels. But some companies may be able to use this easy system to only further confuse and distract consumers from the real facts. (Read more HERE.)

Posted in Health & Well-being, Health Policy

Is Homo Economicus a Psychopath?

PsychopathIn what academics call neoclassical economics, human beings are largely rational, self-interested decision-makers. This stereotypical human, often referred to as Homo economicus, is a creature of coldly calculated selfishness, dispassionately maximizing its best interests even if that comes at the expense of others.

A study in Japan shows that Homo economicus makes up only a minority of the population, but a minority with a wide range of unusual personality traits, including a touch of psychopathy.

To identify people who qualify as Homo economicus (from now on, HE), the researchers asked people to play a series of games. In the dictator game, people were given money and told that their partner (an anonymous person they would never meet) had received none. They were asked how much of that money they would give their partner. Those acting like HE consistently gave their partners no money. Zilch. Their self-interest was maximized by keeping all the money, so that’s what they did.

In the prisoner’s dilemma game, the researchers once again gave people money and asked them how much they would give to an anonymous partner. But this time there were a few twists. First, they were told that any money they gave to the partners would be doubled. So if they received $10 and gave all $10 to the partner, the partner would receive $20. Second, the partner was posed with the exact same opportunity. That means if both people were generous and decided to give the other person all $10, each would actually walk away with $20, for a total of $40. Any selfish behavior would reduce the overall payout. On the other hand, purely selfish people would keep the money for themselves, pocketing the $10 and hoping that the other person was altruistic, therefore giving them a chance to walk away with $30.

There’s a third twist to this study. The researchers artificially controlled the behaviors of the partners in some rounds of the game, so that the research participant would find out that they received $10 from their partner and then be asked how much they would give in return. Those people acting like HE gave their partners no money, even after experiencing the generosity of the anonymous person they were paired with.

I know. Cold. (To read the rest of this article and leave comments, please visit Forbes.)

Posted in Behavioral Economics and Public Policy | Tagged

The Ulysses Strategy

Ubel-Self-Control-1200As the University of Chicago economist Richard Thaler tells the story, a group of fellow-graduate students in economics were at his house one night in the late nineteen-seventies, socializing before the dinner hour. Thaler saw how much they were snacking, and decided to remove the nut bowls from the living room. His colleagues—almost all of whom were ardent proponents of the idea that humans are rational decision-makers, optimizing their best interests through freely made choices—thanked him for removing the tempting snacks. Thaler took mental note of the moment, one of many notes on human irrationality that he would gather in the ensuing years.

That night at his house, Thaler’s colleagues were acknowledging a phenomenon long recognized by people not under the sway of rational-choice theory: that, will power being limited, it is sometimes good to have our freedoms restricted if we’re to act in our own best interests. Ulysses had his minions tie him to the mast as they sailed past the Sirens because he recognized that he would otherwise be powerless to resist their seductions. In recent years, behavioral scientists have expanded on the power of outside constraints, finding, for example, that students given free rein to hand in writing assignments anytime during the semester typically procrastinate and hand in worse essays than those forced by their professors to meet deadlines.

A study published earlier this year in Psychological Science highlights a modern twist on Ulysses’ approach to self-control, showing that people need not rely on their dinner hosts, their minions, or their professors to tie them to the proverbial mast. Instead, they can rely on a strategy of precommitment to potential self-punishment. (To read the rest of this article and leave comments, please visit The New Yorker.)

Posted in Behavioral Economics and Public Policy | Tagged , ,

Will A “Red Light” Be An Effective Nudge To Stop People From Drinking Coke?

So many foods beckoning us from the grocery store shelves – but which ones are healthy for us to consume? We could study Nutritional Facts labels, but that feels as challenging as the math portion of the SAT, with so much numerical information to process. The label tells us how many calories are in the food in question – how many grams of protein, how many grams of fat, and of saturated fat (is that the good or bad fat?). It tells us how many milligrams of cholesterol and sodium, causing many Americans to wonder: is a milligram bigger or smaller than a gram? Consumers have to understand what a gram is, how many calories is too many or too few to eat. And they need to figure out what percent of any given nutrient they ought to consume at any one time.

Nutrition Facts Label Web

To our rescue, or at least the rescue of the British population – comes stoplight symbolism. Food companies are beginning to adopt a simple system of red, yellow (they call it amber in the UK), and green colors, to signal which foods people should avoid or embrace. The stoplight symbol is used to give people quick insight into numerical info about food facts – calories, fat, saturated fat, sugar and salt.

Food high in all five of these ingredients will reveal a red symbol under each category – five red lights – signaling that it is probably not a healthy snack. By contrast, as the National Health Service in the UK informs citizens, “If you buy a food that has all or mostly greens on the label, you know straight away that it’s a healthy choice.”

What a bunch of hooey! (To read the rest of the article and leave comments, please visit Forbes.)

Posted in Behavioral Economics and Public Policy, Health & Well-being, Health Policy | Tagged ,

Medicaid Expansion is Good for Hospitals

The ever reliable Sarah Kliff recently posted a nice graphic, showing a dramatic decline in the number of hospital visits for which hospitals received little to no money, because the patients have no insurance. But this decline occurred almost exclusively in states that expanded Medicaid:

Medicaid Expansion is Good for HospitalsPolitical partisanship prevented many states from expanding Medicaid, despite the huge amount of federal money that would bring to the hospitals within their borders. As hospitals within these non-expanding states suffer, expect business pressure to mount, perhaps to the point that it overcomes our partisan dysfunction.

Posted in Health Policy | Tagged , ,

Debates About the Use of Behavioral Economics in India

India EconHere is the start of a great essay exploring the promise of using behavioral economics in India to promote social goals. Thought you might want to see it.

In his book ‘The Theory of Moral Sentiments’, Adam Smith wrote: “How selfish soever man may be supposed, there are evidently some principles in his nature, which interest him in the fortune of others, and render their happiness necessary to him, though he derives nothing from it except the pleasure of seeing it.” What he wrote in 1759 can be traced as the foundation of behavioural economics, a field that lies at the cusp of psychology and economics. A wide set of our choices are driven and limited by our cognitive ability, attention and motivation. We all are habitué in missing the deadlines; we get impatient and often procrastinate. Over the last decade or so, these behavioural aspects of human behaviour have been incorporated into mainstream economics. Insights from behavioural economics can help us answer several important questions. They can help us understand why attendance rates remain low in schools (often because of poor course design), why some people choose to defecate in the open (often because they find toilets disgusting), how farmers are slow to adopt a new useful technology (often because there may not be enough know-how about this new machine or equipment).Read more at: http://www.livemint.com/Opinion/3wt5jLwXypkr5gZZGKS5vN/The-science-of-human-behaviour-and-modern-policymaking.html?utm_source=copy
In his book ‘The Theory of Moral Sentiments’, Adam Smith wrote: “How selfish soever man may be supposed, there are evidently some principles in his nature, which interest him in the fortune of others, and render their happiness necessary to him, though he derives nothing from it except the pleasure of seeing it.” What he wrote in 1759 can be traced as the foundation of behavioural economics, a field that lies at the cusp of psychology and economics. A wide set of our choices are driven and limited by our cognitive ability, attention and motivation. We all are habitué in missing the deadlines; we get impatient and often procrastinate. Over the last decade or so, these behavioural aspects of human behaviour have been incorporated into mainstream economics. Insights from behavioural economics can help us answer several important questions. They can help us understand why attendance rates remain low in schools (often because of poor course design), why some people choose to defecate in the open (often because they find toilets disgusting), how farmers are slow to adopt a new useful technology (often because there may not be enough know-how about this new machine or equipment).Read more at: http://www.livemint.com/Opinion/3wt5jLwXypkr5gZZGKS5vN/The-science-of-human-behaviour-and-modern-policymaking.html?utm_source=copy

In his book ‘The Theory of Moral Sentiments’, Adam Smith wrote: “How selfish soever man may be supposed, there are evidently some principles in his nature, which interest him in the fortune of others, and render their happiness necessary to him, though he derives nothing from it except the pleasure of seeing it.” What he wrote in 1759 can be traced as the foundation of behavioural economics, a field that lies at the cusp of psychology and economics.

A wide set of our choices are driven and limited by our cognitive ability, attention and motivation. We all are habitué in missing the deadlines; we get impatient and often procrastinate. Over the last decade or so, these behavioural aspects of human behaviour have been incorporated into mainstream economics.

Insights from behavioural economics can help us answer several important questions. (To read the rest of the article, click here.)

Posted in Behavioral Economics and Public Policy

Putting the Sin in Sin Tax

Sin Tax1With Thanksgiving behind us, many Americans will not assemble together for a home-cooked meal again for a while.

By some estimates, people living in large cities consume the majority of their meals outside the home — at restaurants, coffee shops, bars and food trucks. No surprise, then, that anti-obesity policies are increasingly focused on helping Americans make healthier choices when eating in these establishments. Such policies range from gentle informational campaigns (such as the FDA’s calorie count mandate) to heavier-handed policies (such as former New York City Mayor Michael Bloomberg‘s attempt to ban the sale of large sodas).

But with evidence suggesting that calorie information requirements are too hands-off to impact behavior, and with courts concluding that soda bans are too hands-on to be legal, anti-obesity experts are pushing for a more moderate policy intervention. That is why fat and sugar taxes may soon be coming to your local restaurant.

The thinking behind such sin taxes is straightforward: If you make unhealthy food more expensive, people will be less likely to buy it. The problem with this simple way of putting it is it doesn’t capture the complex way people respond to economic signals when dining out. (Please click here to read the rest of the article and leave comments.)

Posted in Behavioral Economics and Public Policy, Health & Well-being, Health Policy | Tagged ,