Behavioral Economics Aren’t that Convincing in Medicine
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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26 Comments
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.
I can't help but wonder how many of these "noncompliant" people are being prescribed "cheaper" medicines that MAKE THEM VERY SICK with no option to get said medications altered. I've been there, and so have plenty of people I know. Doctors do NOT care about your well-being or quality of life, only their hopsital policies and how many medications they can slap on with about as much care as a three-year-old with a box of bandaids. I'm sure there are exceptions to this… out there… somewhere… But I wonder how much noncompliance boils down to bad doctoring. Seriously, no one cares what might happen in five or ten years if the medicine leaves them bedridden and utterly miserable every single time they take it. Not my mom. Not me. Not ANYONE!
I've never not filled a script for a reason other than not being able to afford to.
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.
Dang, this is disappointing… Still important to know when something isn't going to be worth the effort.
Are there significant differences between adults and children, between American patients and patients in other countries? If so, what might those differences suggest about solutions?
i think the conclusion should be that we cant use the usual incentives also you didnt even mention the results of a negative reinforcement method
Ain't no family member of mine gonna know when I take my meds.
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.
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.
I don't need to be bribed like a little kid to take my medicine. I need access to psychiatrists, to treatment. It's silly to assume that non-compliance is due only to patient unwillingness when there are all kinds of barriers involved.
Why compliance and not patient empowerment? Compliance assumes the prescriber is the authority, yet many people avoid medications because of their side effects.
Testosterone pellet injection can deliver meds over a 3 to 4 month period.
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.
Your the best thank you for All your amazing videos
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.
Yeah, lets blame the hundreds of thousands of deaths on non-compliance. Pretty convenient, and takes the weight of responsibility off the doc. Bullshit. Tell the truth. Pills aren't going to fix these people. You boys are going to have to step up your game and address the cause of sick people's diseases—if you actually know.
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!
Lol, they picked some of the least effective mechanisms. The only really effective mechanism in the batch was the optional one
HEALTH-Belief -Modell
What about the DOTS protocol to ensure medication adherence of TB patients? Could you please look into that?
Did you try telling them, "if you don't take this medication, you will die" or "if you want to live, take this medication" ?????????
Church of Medicine requires penance and tith, the peon must love the priest because God has spoken from His Pharma and His School.
interesting take on health care….
Interesting and worthwhile video.
This is so bogus! I would like to see the research showing whether these cardiac patients could AFFORD the medications. $5 maybe buys one of my blood pressure med pills. I am fortunate to have good insurance but I know many people my age (59 and still working) or younger or older who cannot. Medicare sucks and it starts too late for many people. That's why I try to get people to stop saying 'medicare' for all and say medicaid for all – realistically.