Nudging Docs with Threatening Letters

Seroquel tablets. Credit: AstraZeneca, via Associated Press

I recently spoke with Margot Sanger-Katz at the New York Times. She’s an awesome healthcare reporter. She wrote a nice piece on some recent nudging research. Here’s the beginning of the article to whet your appetite:

The letters doctors received from the county medical examiner included a shocking fact: A patient you once prescribed an opioid medication has died in the last year from a drug overdose.

Faced with this statistic and others on annual county prescription drug deaths from the medical examiner, doctors reduced their prescribing of opioids by just under 10 percent, compared with doctors who didn’t get a letter.

Another letter warned primary care doctors that the federal government had flagged them for prescribing too many antipsychotic medications to patients who could be harmed by the drugs. Among those doctors, prescriptions fell by more than 15 percent over two years.

Both letters represented a new experiment in how to use low-cost, behavioral cues to shift medical practices. Instead of offering new training, or taking away insurance coverage, or doing one of the many expensive, complicated things that might change medical practice, researchers have been exploring the power of subtler nudges.

Check out the whole piece!

Want to Prevent Heart Attacks? Perhaps Don't Try This Behavioral Economics Intervention


If you experience a heart attack, you are probably going to need to take pills to prevent another such attack. People who take beta blockers, aspirin, or cholesterol pills after heart attacks are less likely to experience a second such attack. (Note: Don’t take any of these pills until you have spoken to your doctor. These medications aren’t for everybody.)
There’s a problem, though. Lots of people don’t take these pills, even after their doctors have prescribed them. Life gets in the way. They forget to take them, or they run out of pills, or they don’t get to the pharmacy for refills.
To increase the chance people will take these important pills, a team out of the University of Pennsylvania created a behavioral economic incentive. The intervention was multipronged. It included enrolling patients in lotteries, which gave them a chance to win money every day they took their pills. It encouraged patients to enlist a friend to help them stay on track taking their pills, a friend who would get notified every time they skipped their medications for a few days in a row.
(To read the rest of this article, please visit Forbes.)

Is Peer Pressure to Increase Physician Performance Overrated?


It has become trendy in health policy circles to believe that behavioral economic interventions are the key to health system improvement. After all, traditional economic interventions like pay per performance have generated underwhelming results, with little or no change in physician behavior. Why not try a non-financial, psychological intervention—like performance feedback!
Well, a study conducted in the last couple years in Switzerland raises questions about the effectiveness of such feedback. In the study, researchers randomized physicians to either receive feedback every three months (on how many antibiotics they prescribed compared to their peers), or receive no feedback. They hoped that such feedback would shame over-prescribers into prescribing more parsimoniously. The physicians in the intervention group received a one-page letter every three months, with a nice picture showing them their relative rate of antibiotic prescribing.
(To read the rest of this article, please visit Forbes.)

Do We Know How to Promote Employee Health?

According to the Kaiser Family Foundation, lots of companies are encouraging workers to get biometric screening.  Here’s a picture of that:

Kaiser Family Foundation

But is there evidence that this promotes healthier behavior? Would love someone to direct me to any relevant research.

Losing weight is hard. And keeping it off once you’ve lost it–that’s probably even harder. Just ask Oprah.
So maybe those of us who are overweight or obese should simply focus on not gaining more weight than we’ve already gained. Surely that’s easier. Right?
Well, not long ago a group of researchers ran a study testing several ways to keep overweight people from becoming obese. They recruited adults, less than 35 years of age, who were either overweight or teetering on becoming overweight. The goal was to keep them from gaining more weight. In an effort to achieve that goal, they tested a range of interventions:
First, there was the control group. The researchers basically left this group alone, to see how much weight they would gain.
Next was the small changes group. They received two interventions:

Finally, there was the large changes group, which in addition to these first two interventions also received a third nudge–they were persuaded that in order to avoid long-term weight gain, they should first attempt to lose a few pounds.
(To read the rest of this article, please visit Forbes.)

Best Nudge Ever?


Behavioral Science of Eating (in One Picture!)

The Journal of the Association for Consumer Research (yes, there is such a thing!) had an outstanding issue dedicated to eating behavior recently. Here is a picture from that issue worth sharing:
Behavioral Science Of Eating

How Money Makes Us Behave (The Good and Bad)

Money can undermine our morals.  If you don’t believe me, look what happened to a group of four-through-six-year-olds who were brought in for a simple experiment. Researchers asked them to sort objects from a box. Half sorted coins, and half sorted buttons. Then they were asked to do one more thing–try to find their way through a difficult maze with no pencil marks crossing lines. Here is the maze. See how easily you can make your way through it:

Materials used as the persistence tests: the labyrinth puzzle from Experiment 1
Psychological Science

How do you think playing with money affected people’s persistence on this task?
(To read the rest of this article, please visit Forbes.)