Courtesy of
Courtesy of

From skipping a morning jog to texting while driving, humans often act in ways that conflict with their long-term interests — increasingly with deadly consequences, a behavioral economist said.

Temptations — donuts in the office kitchen, a deal alert on a shopping website, a text message — are invading humans’ lives with ever greater intensity and frequency, said Dan Ariely, the James B. Duke professor of psychology and behavioral economics at Duke University.

Everyone knows texting while driving is stupid, Ariely said, but when the phone vibrates as they’re driving down the highway, curiosity takes over and people act in undesirable ways.

Dan Ariely
Dan Ariely

“Those temptations are getting larger and larger, and they’re killing us,” Ariely said recently at the 2016 Further with Ford event in Dearborn, Mich.

The share of human mortality caused or aided by bad decisions has grown from about 10 percent a century ago to about 40 percent today, he said.

“As we invent new technologies, we also invent new ways to kill ourselves,” Ariely said. “Obesity, diabetes, smoking, texting and driving.”

The author of “Predictably Irrational” said that people know of their shortcomings and often try to predict their failures and to work against them, for example by entering a Ulysses pact, named after the mythological explorer who had his fellow sailors tie him to a boat’s mast to be able to withstand the irresistible call of the sirens: People who decide to wake up a half hour earlier to go jogging might put a pair of athletic shoes next to their alarm clock. Or they might use Clocky, the alarm clock on wheels, to make sure they get up.

The world’s complexity is increasing, and humans are struggling ever more to make good decisions about long-term physical, mental and financial well-being, Ariely said. The good news: Humans can design their life in ways that make it easier for them to do the things they want to do — but often struggle to do.

Health care companies, for example, have offered patients money to convince them to adhere to their medication regimen. Ariely said those efforts have yielded limited success.

Humana, too, is running experiments to figure out inexpensive but effective ways to help people overcome their irrationalities and cognitive biases. Some customers of the Louisville-based health insurer recently got phone messages from celebrities such as former New Orleans Saints quarterback Bobby Hebert or “The Brady Bunch” actress Florence Henderson.

The messages reminded people of the importance of taking their medication.

Failure to take medications for conditions such as high cholesterol, high blood pressure or diabetes can lead to medication complications fairly quickly, said Michael Relish, who works on Humana’s consumer marketing and data analytics team.

Florence Henderson HumanaAnd that can mean a reduced quality of life for the patient and higher immediate and long-term costs for the patient, the health care provider and the insurer.

Even with serious conditions, many people do not take their medications. Relish said that only about half of the people who suffer heart attacks take their medications as prescribed a year after the event.

There were 4.3 billion prescriptions written in the U.S. in 2014, yet “fewer than half of patients take medications as prescribed.”

So Humana turned to behavioral economics, which employs psychology, emotions and other factors — rather than just economic principles — to change patient behavior.

“We think of it as aligning their behavior with their intentions,” Relish said.

Humana patients also got reminder messages from their pharmacist and physician, and a combination of celebrity/pharmacist. Humana found that the combination, calls from the pharmacist and Henderson, had the greatest impact — and that calls from the pharmacist worked better in isolation compared to calls from just the physician or just Henderson.

“Future work should investigate whether messages from multiple, distinct sources reinforce each other,” the company said.

Humana also concluded that men and women responded differently to the messaging: “The only significant response for women was to the pharmacist-celebrity messaging, while men responded most strongly to pharmacist messaging followed by physician, then pharmacist-celebrity.”

Humana conducted the experiment with Henderson in Virginia and North Carolina about a year and a half ago, while the Hebert experiment concluded only recently in Louisiana. The results from the second experiment are still being evaluated.

Michael Relish
Michael Relish

Relish said Humana is trying to remove barriers that make it more difficult for people to navigate the complex maze of health care.

In another experiment, Humana, with the help of the University of Pennsylvania, synchronized patients medication refills, meaning it renewed all medications at the same time from the same pharmacy, to increase the likelihood that people would adhere to their medication regimen.

Relish said many of Humana’s customers take multiple medications, and they tend to run out of them on different days, which means more calls and trips to doctors and pharmacies — and a greater chance that the customer forgets to pick up the medications or gets delayed or busy with other chores.

Synchronizing medications resulted in between 3 and 5 percent more participants taking their medications as prescribed at least 80 percent of the time, Relish said. The positive impact was even better for the people whose adherence rates initially were far below the 80 percent. For those tough cases, Humana saw adherence rates jump between 9 and 13 percent.

“That kind of difference is almost unheard of,” Relish said.

Humana is conducting other behavioral economics experiments to nudge people toward behavior that improves their health. Some of those include pill bottles that can determine whether patients have opened it and lotteries that may reward patients financially for good behavior.

According to Ariely, companies are employing all kinds of levers based on behavioral economics to change behaviors — from health screenings to saving for college or retirement.

Money — and the loss of money — can be powerful motivators, he said.

No one has ever woken up and said, “Today I feel like colonoscopy,” Ariely said. People often make appointments for unpleasant medical procedures, but then change their mind on the day of the scheduled procedure even though they understand the benefits of early cancer detection.

However, some medical providers have asked patients to give them a $500 check, which they will get back if they show up for the appointment. Unsurprisingly, most people make it to the appointment.

“Sometimes we recognize that our future self might fail,” Ariely said. “And we do things to make sure our future self behaves better.”

That means humans can create mechanisms, in all aspects of life, to entice them to behave in a manner that is beneficial to them in the long run.

“It’s about helping us create a different environment,” he said.

“If I came to your office every morning and I layered your desk with donuts, how healthy would you be at the end of that year? Certainly less healthy,” he said. “You don’t have to fail every day. You don’t have to fail every time, but if we design the environment this way, you would certainly fail.

“The point is,” Ariely said, “we don’t have to design life like this. We can design things to be better.”

Boris Ladwig is a reporter with more than 20 years of experience and has won awards from multiple journalism organizations in Indiana and Kentucky for feature series, news, First Amendment/community affairs, nondeadline news, criminal justice, business and investigative reporting. As part of The (Columbus, Indiana) Republic’s staff, he also won the Kent Cooper award, the top honor given by the Associated Press Managing Editors for the best overall news writing in the state. A graduate of Indiana State University, he is a soccer aficionado (Borussia Dortmund and 1. FC Köln), singer and travel enthusiast who has visited countries on five continents. He speaks fluent German, rudimentary French and bits of Spanish, Italian, Khmer and Mandarin.


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