Peter Ubel

It is a dangerous time to compromise in the U. S. government. A Republican working with Obama is dead meat in the next primary. A Democrat who works with Republicans? Well, you saw what happened to Joe Lieberman the last time he ran as a Democrat.

Politicians are understandably worried that if they collaborate across the aisle, their political careers will soon end. They fear losing their next election.

But their fears are misplaced, at least from my perspective as a researcher who has studied the kinds of ways people mispredict what will make themselves happy or miserable.

People frequently overestimate the emotional impact of adversity. Early-career professors imagine that if they fail to receive tenure they’ll be miserable the rest of their lives, even though long-term studies show that tenured positions have no impact on well-being. Making these same mistakes, elected officials assume that if they lose the next election, they will be miserable. In making these mispredictions, they focus too narrowly on the feelings they will experience as the results of their election loss trickle in – the shame of the failure, the challenge of telling staff that they’ll have to find new jobs, and the misery of giving up all that power and prestige.

But what happens to legislators after they lose elections? Remember, these are often very talented people, with large social networks and often with access to lots of money, through previously accumulated fortunes or through the business connections they have developed in office. These people more than land on their feet again. Most of them thrive. They live extremely full lives, working at the intersection of business and government. Fromrom what I’ve seen, I’d guess that most of them are happier than they were when they were in the government. I mean look at those cool eyeglasses Tom Daschle started wearing after he lost his reelection campaign. And how about Al Gore and his Nobel Prize!

Indeed, I would go a step further in characterizing politicians’ mispredictions. Most imagine, incorrectly, that losing the next election will make them miserable. Instead, I’d guess that doing what it takes to get reelected is really what will make them miserable.

That brings us to Bart Stupak, Democratic Congressman from Michigan — notable for his pro-life views as well as his embrace of social programs to help poor people. When Stupak considered whether to vote for health care reform legislation, he found himself attacked from the left for focusing too much on making sure that such reforms did not expand federal funding for abortions. And he found himself attacked from the right, for supporting Obama’s “socialist” agenda. By looking for middle ground, a compromise, he set himself up for a very difficult election campaign.

But he didn’t care. He thought the legislation was important enough that he was going to do what he thought was right, even if that made everyone angry. And now, he is retiring, rather than face a brutal reelection campaign. And here is my prediction: he will soon be a very happy man. He will be able to look back on the end of his political career convinced that he acted on principle to do what he thought was best for the country, regardless of the political consequences of those same actions.

By caring more about his country than he cared about his political fortunes, Stupak has taken a large step towards living a happy and fulfilled life.

Let that be a lesson to all his colleagues, as they fret over their next reelection campaign.

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So many books, so little time.

I am 47 years old. Assuming, in a near best case scenario, that I live 40 more years, and that I read around one book per week the rest of my life, I will finish 2,000 more books before I die.

That’s a lot of verbiage. But think about all the wonderful books that have already been written-not hard to come up with 2,000 that would be nice to peruse before I perish. And now think about all the wonderful new books likely to be written over the next 50 years. How do I choose which books to read?

With so many books and so little time, the choices become daunting.

But choose I must. For if I remain frozen in indecision, my reading efforts will stall. Then, time will pass me by. Time, after all, doesn’t pause, even if my reading efforts do.

But moving forward is better than standing still. Indeed, we all need to move forward, even if the “best” direction forward is not totally clear. That is one of the take home points of Sheena Iyengar’s wonderful new book-The Art of Choosing. Iyengar is a behavioral scientist at Columbia, most famous perhaps for her “jam study”-in which she showed that people facing a choice between too many flavors of jam walk out of the grocery store without buying any jam, too frozen by indecision to make a choice even though any of a dozen flavors would have made them happy.

Iyengar’s book ranges widely over the kinds of choices we make in our lives, from grocery store decision making to the momentous choices that lead us to wedding chapels. Her discussion of arranged marriages is touching and illuminating.

Her book is what we need more of in popular psychology-an accessible eloquent and even moving tome that is nonetheless grounded in the most rigorous of psychological science.

2,000 books left in your life? I suggest reading Iyengar’s The Art of Choosing before you allow yourself to be bogged down in indecision.

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Answer = Himself

Question = Who is Mark McGwire trying to deceive?

It’s laughable, isn’t it.

• He took steroids for “health reasons”
• The drugs “didn’t help him” hit home runs
• The “steroid era” made him do it

Mark McGwire’s belated confession to using performance enhancing drugs was only surprising in his determination to call them “health enhancing drugs.” And even that wasn’t all that surprising.

I could easily go off on what a total jerk McGwire is. But I’m a big believer in trying to understand where people are coming from before judging them. And here is my most generous take on McGwire’s story.

1. He didn’t lie to Congress: Did you hear that, Manny Sosa?

We all know that when McGwire took the 5th in front of Congress, he was indirectly admitting steroid use, but trying to avoid criminal charges. It was a pathetic moment, no doubt, but it actually takes real courage to make such a jerk out of yourself. The cowardly way out would have been what other people did-lie in front of Congress. See: Op cite to Mr. Sosa!

2. He admitted to using “andro” while still playing baseball. So it’s not like he thought people were unaware of his use of performance enhancing drugs. (OK: he only confessed to using andro after reporters saw a bottle in his locker. Score this one a C-.)

3. He undoubtedly convinced himself that it was okay to use steroids. This is the power of cognitive dissonance, people.

• He always knew himself as a great homerun hitter: “They are still talking about my high school homeruns for gosh sakes.”

• It is easy for people to slide into immorality. He undoubtedly strained some muscle, somewhere, sometime in his career, and was itching to get back to full health. His use probably started around then, with a dash of andro, maybe a teaspoon of HGH. This is how good people end up doing bad things-one step at a time.

• Self-justification is so human: “Everyone was doing it”, or so it seemed. To not take performance enhancing drugs (oh I mean, health enhancing drugs!) would have felt, to McGwire, like it was putting himself at a disadvantage.

• Having taking these steps, he was in full cognitive dissonance mode. He knew he was a good guy, heck-he visited children’s hospitals in his free time. So it must, therefore, be okay to use these drugs.

4. He has now had more than a decade to develop a story that solves all his internal contradictions-that makes his steroid use something that a “good guy” can do.

So here is my final and overly generous version of Mark McGwire’s life story: The guy probably is a good guy. He’s a cheater and a coward, and he is self-delusional. And he never (!) could have beaten Roger Maris’ single-season home run record without the help of home run enhancing drugs.

But the steroid era in baseball was a time of mass delusion. Fans, baseball officials and players all convinced themselves that comic-book physiques were the result of advanced weight lifting techniques, and not the result of new drugs.

I don’t admire McGwire, but I don’t completely condemn him either, given that the majority of his colleagues were doing things as bad or worse than he was back then. But I pity him for his self-delusions.

Now if you don’t mind, I need to step into the kitchen for a dose of an alertness enhancing drug, which I have deluded myself into thinking of as a cup of coffee.

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Easy to criticize the Obama administration, isn’t it?

Look at the unemployment rate, for example. And have you seen the tax hikes they’re going to need to pay for healthcare reform? Oh yeah, and they did a great job with Umar Farouk Abdulmutallab didn’t they?-his dad told us he was going rogue, and then when he buys a ticket with cash and doesn’t check in any luggage, we look the other way. Time to say this in unison now, folks, with your most sarcastic tone of voice: “Great work Obama!”

Or is it too soon for such sarcasm?

Folks, before we start blaming the government for all these terrible things, we need to remember that hindsight is not even close to 20/20, and that we cannot accurately judge what our government is doing or not doing for us until we pay attention to what I call “the Politics of Invisibility.”

You see, there is some invisible stuff we need to pay attention to.

Let’s start with our unemployment rate. I live in Michigan, and I’m one degree of separation away from a hell of a lot of unemployment. I am not at all happy about our nation’s economy. And I’d like to have seen us make more progress over the past year in addressing our economic woes. But before we criticize Obama’s economic stimulus plan-on the grounds that it has not ended unemployment as we know it-take a moment to ponder the invisible: ask yourself what the employment rate would have been if Obama hadn’t pushed his stimulus plan through a reluctant Congress. Don’t know the answer? Welcome to the Politics of Invisibility.

How about the taxes we will pay to fund healthcare reform. At first glance, it seems that there’s nothing invisible there. But take a closer look. Do you have any idea how much of your current income has been funneled into the healthcare industry? Consider that “free” healthcare benefit your employer gives you. That benefit comes out of your income. Many middle-salary wages, in fact, have stagnated in recent decades in the U.S., largely because employers have been taking what would be salary increases and pushing them over to cover the spiraling cost of healthcare benefits. And that tax break we get for our employer-based health insurance? That’s not free either. That contributes to government deficits, and ultimately forces the government to raise taxes. Nothing is free. But because of the Politics of Invisibility, we find ourselves whining about healthcare taxes at the same time we overlook the way healthcare insurance has already shrunk the size of our paychecks.

Finally, let’s revisit the TSA’s performance in the recent underwear bomber fiasco. I admit to being shocked, with the rest of the nation, at how many clues the Feds overlooked in allowing this man to board a plane with a bomb strapped to his crotch. But a moment’s reflection on the Politics of Invisibility forces us to take a more cautious view of the TSA. Consider one of the smoking guns that critics of TSA have been discussing vehemently in the blogosphere-that this terrorist stepped onto the plane WITHOUT CHECKING ANY LUGGAGE.

Ummmm, I think he means he placed his luggage into the overhead bin. You know, like half of his fellow passengers!

Now I understand that most of those other passengers’ fathers hadn’t recently told the CIA that their son was becoming radicalized. And that most of them hadn’t paid for their tickets in cash. But I don’t know, as an ordinary citizen, just how many people would have fit the underwear bomber’s profile. How many young men have come under the influence of passionately radical Imams and then boarded planes after paying for tickets with cash? I don’t know that number. I expect the number is in the tens of thousands, if not more. (And is paying in cash really that significant? If we started scrutinizing cash payments, wouldn’t terrorists simply start using credit cards? For that matter, wouldn’t they start checking luggage, if that turned out to be a security red flag?)

What’s invisible here is the denominator-how many people, if they try to blow up a plane tomorrow, would have a string of “clues” that would have made the bombing attempt look inevitable? It may very well be that very few people were as risky-looking as the Underwear Bomber. But frankly, that information is invisible to me, as it is to most of the general public.

Before we get all high-and-mighty about the terrible job that security experts are doing, we need to ponder the Politics of Invisibility, and remember that it’s easy to criticize what we see, even as we ignore what we can’t.

Peter Ubel is George Dock Collegiate Professor of Medicine at the University of Michigan, and author of Free Market Madness: Why Human Nature is at Odds with Economics-and Why it Matters (Harvard Business Press, 2009). Visit http://www.peterubel.com/ for more blogs and research updates.

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Would you rather experience a bad situation forever or for just six months? Any sane person would choose the temporary situation. And yet, according to a study I published this week, if you chose the temporary situation, you’d be more likely to suffer over the next six months-so focused on the hope that your situation would soon improve that you’d have a hard time coping with your current fate.

Many people voted for Barack Obama in hopes that he’d extricate the country from a whole array of bad situations. Now they wait, with hope, for things to improve. In the meantime, however, they are having a hard time coping with the economy, the situation in Afghanistan, and even with the drawn out process of reforming our health care system. And so they criticize Obama for not making things better, faster.

Barack Obama is being bedeviled by the dark side of hope.

In our study, Dylan Smith, George Loewenstein and I measured the happiness of people who had just undergone a colostomy surgery. Because of disease in their colons, the people had had their bowels rerouted to exit in a pouch on the side of their abdomen. For about half of the people receiving this surgery, this colostomy was permanent. But for the remaining people, the lucky ones, their doctors were confident that over the next six months, they’d be able to get their bowels reconnected. Their colostomies, in other words, were temporary.

Over the next six months, it was this “lucky” group that suffered. The people with permanent colostomies, forced to reckon with the cards they were dealt, emotionally adapted to their situation. The people with temporary colostomies, by contrast, remained frustrated by their situation, waiting impatiently to trade their cards in, so to speak, for better ones. They suffered from the curse of high expectations.

Barack Obama’s popularity has dropped significantly in recent months. Part of this drop was expected, given the height of his popularity after the election. But Obama’s popularity is also sinking because his supporters are becoming impatient. They elected Obama so he’d fix the economy, and the health care system, and the Middle East. Now Obama’s supporters are like those people with temporary colostomies: they know that improvement will take time, but that doesn’t make it easier to cope with the country’s current troubles.

A prisoner sentenced to life without parole is in a worse situation than one with only six months remaining in his sentence. But it is this latter prisoner who is more likely to attempt to escape. The anticipation of freedom, of a better life, is so strong that he can no longer wait.

The strong emotions elicited by our President are not merely a measure of his performance to date; they don’t merely arise because he has failed to resolve all the crises he inherited.

They are also evidence that, for many Americans, Barack Obama still inspires hope.

Peter A. Ubel M.D. is author of Free Market Madness: Why Human Nature Is at Odds with Economics-and Why It Matters (Harvard Business Press, 2009). The study discussed in this essay appears in the November 2009 edition of Health Psychology.

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If I told you that neighborhoods cause people to develop diabetes, would you believe me? And would that make you more or less willing to see your tax dollars spent researching ways to treat and prevent diabetes?

That is essentially the question my colleagues and I posed to a wide swath of Americans, and a question, we discovered, that polarizes people along political party lines.

What do I mean when I say that neighborhoods can cause diabetes? Well, social scientists have linked neighborhoods to disease. People living, for example, in neighborhoods with poor sidewalk access end up walking less than people in other kinds of neighborhoods, thereby gaining weight and developing diabetes. By a similar token, if a neighborhood is too dangerous for people to exercise outdoors, people become more sedentary and, voila, diabetes predictably ensues in a subset of the population. What’s more, some neighborhoods have a terrible supply of grocery stores — people living in such neighborhoods can easily avail themselves of fast food restaurants, but can’t necessarily find fresh produce.

Often when people learn that forces beyond individual control contribute to illness, they become more supportive of public funding to combat those illnesses. In fact, in our study we provided a random subset of research participants with a news story explaining that diabetes is caused by genetics (this is true, by the way — genes do contribute to diabetes.) People reading this news story — whether Republican or Democrat — became more supportive of spending public funds to treat and prevent diabetes.

Then we gave another subset of participants a different news story. This one explained that diabetes is caused by neighborhoods. Once again, hearing about the forces that contribute to diabetes made Democrats more interested in spending money on diabetes research. But the Republicans who read this news story weren’t persuaded; in fact, they became less willing to use tax money to tackle the diabetes epidemic.

It is easy to believe that our country is politically polarized simply because people have gravitated toward partisan media outlets. Watch Fox news and you will hear about Tea Party demonstrations; watch MSNBC and you will hear about Gay Rights demonstrations. No surprise that when people receive imbalanced information, they end up with polarized attitudes.

However, our study shows that our nation’s political divisions run much deeper than the Glenn Beck/Keith Olbermann divide. In our study, Republicans and Democrats came to starkly different opinions from each other even after receiving identical information about the cause of diabetes. Hearing about neighborhood effects on diabetes brought out compassion among Democrats, but not so much among Republicans. As some of my Republican friends tell me when I talk to them about neighborhoods and illness: “The neighborhood doesn’t force people to eat at McDonalds. Even if a neighborhood is dangerous, people can do Pilates in their living rooms if they’re motivated.”

True enough. Human behavior is ultimately the main cause of diabetes. But no person’s behavior is completely under their own control. Social forces can influence people’s behavior — the kinds of social forces that differ across neighborhoods, for example. Sadly, when people think about these other forces, some are more convinced than others, and these divisions run across predictable party lines.

To reduce partisanship in this country, we need to educate more people about the complexity of human nature. I wonder if the 24 hour news channels will find the time to do that!

Our study, led by Sarah Gollust, was published in the October issue of the American Journal of Public Health.Free Market Madness. Read more of my blogs here.

My most recent book is

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One of the greatest joys of practicing medicine is for me to understand where my patients are coming from, so I can best help them through their medical journey. I was reminded of this fact recently, when talking with a patient who had just come back to my primary care clinic after visiting the liver clinic to discuss his chronic Hepatitis C infection. His liver function was still quite good, but his blood tests and liver biopsy showed ongoing liver damage. If this continued, there was a good chance my patient would soon find himself with a failing liver.

At the liver clinic, he had met with a concerned and caring physician who talked to him about how serious his liver disease was, and who explained the pros and cons of treatment. When the patient returned to my office, it was clear that he had been well educated. He knew that treatment had about a 50% chance of curing him and that, for the majority of patients, the treatment was long and arduous, making them feel like they had an unending case of the flu. With this information in mind, and with vivid recollections of past bouts with the flu, my patient decided to forgo treatment.

His visit with the liver doctor was, by all measures, a paradigm of autonomous decision making. My patient was intelligent, informed and clear about his preferences, and yet I found myself unable to accept his decision at face value. I gently pushed back: “I’ve taken care of a number of patients this year who went through this same treatment who discovered that it wasn’t nearly as bad as they thought it would be,” I told him.

And that’s when the two of us came up with a third alternative: a trial of treatment. My patient was understandably overwhelmed at the thought of months of flu-like symptoms. He didn’t even know how severe these symptoms would feel, so it was difficult for him to commit himself to extended misery. But his decision didn’t have to be all or nothing. What if he started treatment with the option of quitting if he found it intolerable? I laid the idea out for him: “You might find out that it is not so bad after all. But if it makes you miserable, and you don’t want to go on, I will support you.”

He returned to the liver clinic and told the specialist he was ready to start treatment.
Emboldened by my experience with this man and his hepatitis treatment, I have increasingly looked for third routes for patients who I fear might be making bad decisions because they haven’t seen all the possibilities. I call it my “all or something” strategy.

So you won’t be surprised at what I proposed to a patient I met one day who was reluctant to receive monthly shots to prevent recurrence of his prostate cancer. He was afraid that the monthly shots would be uncomfortable. It was our first visit together, and I was talking to him about his general medical history. He had already received treatment for prostate cancer, and his urologist had recommended that he receive a monthly injection of a medication that would reduce the chance of recurrence. But he was tremendously afraid of needles. Hated them in fact. And the thought of a monthly injection was simply too much for him to contemplate.

I talked to him at length about this decision, skeptical that fear of needles could dissuade him from a potentially life-changing treatment. Was he afraid of the side effects of the medications? No, he wasn’t. The cost of the medication? Not at all. Did he trust his urologist? Had they had a bad interaction? No. In fact, he was delighted that the urologist happened to be African American, like he was. But that didn’t mean he was going to put up with a monthly injection.

At this point I spun the discussion over to my “third way” approach. I suggested that he try a monthly injection once, to see what it felt like. Maybe it wouldn’t be such a big deal. Then he could try it a second time, and continue the treatments only as long as he decided that they were worthwhile.

He rejected my idea. I honestly could not understand how any human being could be so afraid of a little needle that he would turn down a treatment that might forestall the recurrence of a life-threatening cancer.
As I sat there, confused about this man’s decision, he looked at me and said: “You’re the first doctor who really understands me.”

I neither comprehended this man’s decision, nor understood what in the history of his life would have led him to make this decision. But I did understand one thing that day: that the proper practice of medicine is about striving for understanding even when we cannot obtain it.

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Did you know that Adolf Hitler had three testicles?

You didn’t? Well, you are right. That is just an urban legend — one that I have just created.

In fact, if anyone tells you that Hitler had three testicles, they are either misinformed or they are lying.

Why am I mentioning Hitler’s three testicles to you right now? Because by mentioning the myth of his three testicles, and debunking that same myth, I am actually increasing the odds that some time in the future you will mistakenly believe that Hitler really did have excess, um, baggage.

Behavioral scientists have discovered that familiarity breeds belief. In research studies, they have exposed people to series of true and false messages, telling people at the same time which of those messages were true or false. Later, they exposed people to these same messages, and asked them whether they thought the messages were true or false. They found that previous exposure to these messages increased the number of people who believed these messages were true, even the messages that had been identified as false.

How does this happen? People remember hearing the message (“Hmmm, three testicles, that sounds familiar”), but forget learning that the message was false.

Therein lies the brilliance of Sarah Palin’s death panels. Having heard this rumor countless times now, casual observers of politics (a.k.a. the majority of the American public) will come to believe that the rumor is true.

Lying, unfortunately, can be smart politics. And countering those lies by pointing out their falseness — that won’t be enough, if we believe what behavioral scientists have learned.

Proponents of health care reform must not only debunk these myths, they must also create powerful images to counter those myths — images of how health care reform would improve people’s lives. Images that can compete, if not with extra testicles, then at least with Sarah Palin’s face book page.

To learn more about my new book, Free Market Madness, check out my website: http://www.peterubel.com/.

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American presidents have been trying to reform our health care system since at least the Nixon era, but with only limited success. Past reform efforts have failed for many reasons. For starters, the U.S. health care system is complex, with the medical industry making up almost 1/6 of our economy. But perhaps the biggest obstacle to reform is a psychological one: thoughts of health-care reform too often trigger images of putting for bogey instead of putting for par.

I am referring to the psychological power of loss aversion, a phenomenon that behavioral economists have been studying for several decades now. Most of us, you see, seek to avoid losses with greater fervor than we seek to achieve equal gains. If given a 50-50 chance of either winning or losing $100, we decline. The $100 loss looms larger than the $100 gain. For similar reasons, most people express greater interest in surgical procedures that carry 90% survival rates than in ones that carry 10% mortality rates, even though these procedures are identical. Thinking about mortality triggers loss aversion. This week we even learned that loss aversion influences putting behavior among professional golfers. When putting to avoid a bogey, golfers are more aggressive than when putting for birdie, and consequently are more likely to make their putts. Few things are more motivating than the desire to avoid losses.

Which brings us back to health care reform. When President Clinton attempted an overhaul of our health care system in the 90′s, his administration correctly recognized the need to control health care costs. Without cost containment, they knew it would be impossible to expand health care insurance to the millions of people who lacked such coverage. So the Clinton administration looked for ways to increase the number of Americans enrolled in managed care plans, which at that time had achieved some success in controlling health care expenditures.

The problem with the Clinton approach was that it made Americans feel like they were losing their traditional health care. Managed care was infamous for saying no — for denying people health care services and for limiting their choice of doctors. By taking things away from people, managed care triggered loss aversion. Consequently, the American public never supported Clinton’s reform efforts.

The Obama administration is steeped with people knowledgeable about behavioral economics, who hope to keep the public from slipping into a state of loss aversion. Not surprisingly, then, the administration has enthusiastically embraced research out of Dartmouth University, demonstrating huge regional variations in medical expenditures that have not been accompanied by any variation in health care quality. According to this research, some cities in the US spend twice as much per capita on health care as other cities without experiencing any discernible improvement in health.

Obama’s people hope that Americans will perceive health care reform as a win-win opportunity, with lower health care costs through the elimination of waste and inefficiency, accompanied by more stable and secure health care coverage. But even if the administration succeeds in assuaging the fears of the general public, they face a much stiffer challenge with the health care industry. Any success they have in controlling health care costs will, after all, create losers. If we spend less money on health care in the US, then someone in the health care industry is going to take a financial hit. One person’s waste is another person’s income.

No surprise, then, that both the insurance industry and the AMA have begun pushing back against elements of the Obama plan. These groups stand to lose money under health care reform. Hospitals are likely to lose money too, as are drug companies, medical device companies, and other powerful parts of our vast health care industry. All of these groups will be motivated to fight health care reform.

The Obama administration has made a point of distinguishing its behavioral approach to economics from the more traditional approach embraced by the Bush administration. Ironically, though, it is the Bush administration that understood how to pass health care reform without triggering loss aversion. When George W. Bush decided to push for a Medicare drug plan, he recognized that the pharmaceutical industry would wield its powerful lobbying strength against his efforts if they feared a loss of income. So he crafted a plan that benefited the drug industry. Politicians on the left criticized these concessions to industry, but it is hard to imagine the drug plan passing without such concessions.

Obama should draw a lesson from his predecessor. If he causes the health care industry to perceive his health plan as a threat to their incomes, his plan will face stiff resistance. For health care reform to succeed, people in the health care industry need to keep making exorbitant sums of money for awhile. Over time, the government can gradually ratchet down health care costs. But initially, Obama needs to reduce the number of people who perceive health care reform as a loss.

The cost will be steep. But the alternative will be more costly. We cannot afford to make reform feel like a health care bogey.

Peter Ubel is author of Free Market Madness: Why Human Nature Is at Odds with Economics — and Why It Matters (Harvard Business Press, 2009), and Director of the Center for Behavioral and Decision Sciences in Medicine at the University of Michigan.

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Last summer, New York City made a great stride toward promoting public health, by requiring chain restaurants to prominently publish calorie counts alongside their menus. This type of regulation holds the promise of improving people’s eating habits, without restricting their freedom to order whatever they want.

Theoretically, this new regulation should help consumers make better choices: they should eat fewer big Macs and more Asian chicken salads. Indeed, proponents of free markets, who normally oppose government regulation, should celebrate New York City’s new policy, because, by requiring restaurants to inform consumers about their purchases, the city has moved the restaurant business closer to Adam Smith’s ideal of a free market-one where savvy and educated consumers choose among available goods based on their cost and benefits.

As a physician who conducts research in behavioral economics, however, I am concerned that this policy won’t accomplish its goals, because it should be simple for restaurants to make their offerings attractive to even the most calorie conscious consumer.

How will they do this? By creating new items on the menu that make everything else look healthy by comparison.

When people evaluate consumer goods, they usually need some context in which to judge relevant attributes of competing products. What counts as an expensive DVD player? Best way for me to tell is by looking at other DVD players. And what counts as a low-calorie meal? Easiest way to tell is to see how many calories are in other meals.

If I was a restaurant owner and wanted to keep selling a popular high calorie sandwich to New Yorkers, I would place two new items on my menu, each with 50% more calories than the old sandwich. Maybe add on a couple slices of bacon, or a fried egg . . . anything Homer Simpson would like on his sandwich.

I expect that very few customers would thrill at the idea of these new “heart attacks on a bun.” Most will recoil. But that’s ok, because my goal would not be to attract customers to these new sandwiches. Instead I would use these new sandwiches to make my old ones look better. You see, my customer’s eyes will soon wander toward other items on the menu, and what used to be the highest calorie sandwiches will now look like veritable health-food snacks!

I have no idea whether any restaurants will employ this psychological technique. I do know that companies often make high-priced products, deluxe car models for example, in large part to sell their midrange products.

More importantly, my example highlights the kind of unconscious behaviors that could reduce the impact of New York City’s new regulations.

I hope that I am wrong, and that restaurant goers begin eating more healthfully in response to the calorie information now available to them. But if they don’t, I expect New York City will need to go further, to persuade people to eat better food.

Helping consumers make good choices often means we need to do more than simply inform them.

To read my other blogs, and to learn about my book Free Market Madness: Why Human Nature is at Odds with Economics-and Why it Matters , check out my website at: http://www.peterubel.com/.

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