The Brain, Money, and Patient Compliance
Mind Games by John Cassidy (New Yorker Sept 18, 2006) does not directly address patient compliance or adherence, yet it does offer valuable insight in the process of decision-making, including healthcare decision-making.
For some time, I’ve railed against the Rational Man fallacy,1 especially as it applies to theories of patient compliance.
The same mental and psychological processes involved when individuals make investment decisions, the focus of this article, are, I would hold, similar if not identical to those involved in making healthcare decisions and in determining compliance.
The author’s point of view is neatly summarized in his statement,
I sometimes wonder what goes on in my head
when I make stupid investment decisions.
Happily for him and us, the writer became involved in neuroeconomics research being carried out at New York University’s Center for Brain Imaging, using imaging technology to examine the neurology of decision-making as it pertains to economics.
The article describes the imaging research, explains how its findings correlate with observations about irrational decision-making derived primarily from studies by economists and psychologists, and examines the implications for investment behaviors.
The article is interesting and rewarding so providing a comprehensive review is less efficacious than simply recommending that it be read from the perspective of its possible applicability to healthcare decision-making as well as economics.
Toward that end, it is worth noting that, until the 1970s, academic economists and psychologists had little to do with one another, at least not since the 1800’s, when they were both considered “moral sciences.” Psychology then became progressively more empirical, based on quantifiable observations of human behavior. Simultaneously, economics became, in many ways, a theoretical science focused on mathematical models and predictive equations. This attempt to reduce economic behavior to mathematics led theoreticians to create Homo economicus, an individual whose psychological state was invariable and whose decisions were always rational. To be fair, economists have routinely acknowledged the hypothetical and arbitrary nature of this version of Rational Man, but this concept, a legitimate tool for exploring ideas when carefully used, has seduced many economists, politicians, and other professionals into ill conceived actions based on the assumption that the human beings actually involved in whatever schemes being concocted would behave as rationally as the hypothetical Economic Man. Eventually, stock market and housing bubbles, retail shopping frenzies, and similar “irrational” phenomena coerced the admission of the limitations of the Rational Man assumptions. In the last 25 years, more and more economists have used ideas and insights from psychological studies to study investment behavior.
I would hold that healthcare academics and clinicians have fallen into the same trap as the economists, albeit for less apparent reasons and having made less apparent progress toward rectifying this fundamental error.
The concluding sentences are also worth quoting:
We are not going to falsify all of traditional economics, … but we are going to point to a whole range of biological variables that traditionally have not been included in the analysis. In economics, that is a big change.
Substitute “Compliance Theory” for “economics,” and that rings true to my ears.
- Rational Man and Economic Man are terms used in economics, law, and other settings to stipulate a hypothetical individual that uniformly and inevitably acts logically to achieve the highest possible well-being for himself using whatever pertinent information is available. More formally, The Washington University Economic Geography Glossary defines Economic Man as the “Highly abstract model of human economic behavior based on simplifying but extreme assumptions of perfect information and perfect ability to use such information in a rational way (i.e. to achieve optimal ends)” [↩]