October 16, 2008
Today, I will be delivering the Eighth Annual Marshall J. Seidman Lecture on Health Policy at Harvard Medical School. (Here are the slides from my talk.) The title of the lecture is "New Ideas About Human Behavior in Economics and Medicine," and it builds upon a theme I have been speaking about over the past few months: that just as the field of economics suffered for ignoring psychology for too long, so too has much of medical science and health policy largely ignored the crucial role of expectations, beliefs, and norms. (The broader lesson is that theallure of pure science -- which works beautifully in physics and some other fields -- can go astray when the subject involves human beings.) The placebo effect is perhaps the most compelling example -- onethat tends to be dismissed as a statistical annoyance rather than examined in and of itself, even though it is often more potent empirically.
Greater emphasis on the psychological and sociological influences on human health could lead to improvements in many areas of health care and medicine. For example, ICU doctors in Michigan drastically reduced the rate of infections associated with catheterizations through a shift in professional norms brought about by the institution of a simple five-step checklist. Setting default rules that are more in tune with the realities of human behavior in such diverse settings as doctors' offices and federal nutrition programs might help to improve a range of health outcomes, from the adherence of patients to their doctors' medication regimens to the proportion of Americans eating a healthier diet and exercising more.
Just as economists have put behavioral insights to use in the retirement and pensions fields to boost personal savings, especially among those at the lower ends of the socioeconomic spectrum, thinking carefully about these intersections between psychology and health care is vitally important because of a pair of disturbing trends in the United States today: the rapidly rising share of the nation's income devoted to health care costs, and the growing gap in life expectancy between those at the top of the socioeconomic distribution and those at the bottom. Greater attention to the insights of behavioral economics in medical science and health policy may help to mitigate both of these trends.