Adam,
I don't disagree. Health care reporting over simplifies, exaggerates
effectiveness, and rarely considers long term outcomes.
Cheers,
Arlene
On 13-04-12 2:08 PM, "Adam Oliver" <[log in to unmask]> wrote:
> It might be good to experiment with these initiatives, Arlene, but so far the
> evidence suggests that initiatives that target sustained behaviour change
> (such as weight loss) are rarely if ever sustained beyond the relative short
> term. All these bits and pieces of evidence that report positive effect, of
> which there are probably now hundreds, tend to focus on the short term.
> There's a good reason for this - those who are peddling these initiatives
> often have a vested interest in them.
>
> -----Original Message-----
> From: Anglo-American Health Policy Network [mailto:[log in to unmask]] On
> Behalf Of Arlene Bierman
> Sent: 12 April 2013 18:39
> To: [log in to unmask]
> Subject: Re: Nudge and money
>
> Fascinating exchange.
>
> From Todays Globe and Mail
> The best way to lose weight? The Biggest Loser may be on to somethingŠ
> http://www.theglobeandmail.com/life/the-hot-button/the-best-way-to-lose-weig
> ht-the-biggest-loser-may-be-on-to-something/article11048768/
>
> "Want to motivate your family members to lose weight? Forget pleading them to
> do it for health reasons. They¹re more likely to slim down if promised some
> cold, hard cash.
>
> Last month, The Hot Button noted that a study conducted on Mayo Clinic
> employees showed people successfully shed extra pounds when money is at stake.
> Now, new research suggests people are even more likely to reach their
> weight-loss goals when they are pitted against one another for a share of the
> winnings."
>
> Arlene Bierman
>
>
>
> On 13-04-12 1:10 PM, "Uwe E. Reinhardt" <[log in to unmask]> wrote:
>
>>
>>
>> This has been an interesting exchange, so far, and I hope it will
>> continue, so that I may learn from it.
>>
>> If, after 20 years of working in the field of behavioral economics,
>> Adam still "hasn't mastered it by any stretch of the imagination,"
>> imagine the plight of a little country economist from rural New Jersey.
>>
>> When asked at dinner parties what behavioral economics is, I try to
>> get off the hook by explaining that one can think of behavioral
>> economics as an academic seminar to which psychologists and other
>> disciplines have been invited and at which at least some economists
>> discard their century-old hauteur to listen to insights from other
>> disciplines.
>>
>> So a kindly psychologist might explain to us that people actually do
>> not cope with uncertainty in the elegant and simple way imagined by
>> the von-Neumann-Morgenstern algorithm. Or we learn that the reaction
>> of people to probabilities depends strongly on how that probability is
>> described to them:
>> "out of 100 patients undergoing this procedure, 4 die" vs. "out of 100
>> patients undergoing this procedure, 96 survive." We learn that "more choice"
>> or "more options" is not necessarily better, something some standard
>> economists have trouble grasping.
>>
>> Thus educated, behavioral theorists then think of ways to structure
>> the context in which decisions are made in a way that leads to choices
>> that are somehow desired by the structurer. At least that is what I
>> think of as the normative branch of behavioral economics.
>>
>> Viewed in this way, behavioral economics is more than just an attempt
>> to shore up standard economic analysis. It is an attempt to build
>> models of systematic human behavior based on axioms and hypotheses
>> that come closer to life here on earth rather than to life on planet
>> Econ, as Tsung-Mei Cheng had put it so nicely at a talk at iHEA
>> Toronto in the attached slide. It is an attempt to bring models of
>> economic behavior back to earth from outer space, to where mathematical
>> standard economics had blasted it.
>>
>> Best,
>>
>> Uwe
>>
>>
>>
>>
>> -----Original Message-----
>> From: Anglo-American Health Policy Network
>> [mailto:[log in to unmask]] On Behalf Of Michael Gusmano
>> Sent: Friday, April 12, 2013 12:25 PM
>> To: [log in to unmask]
>> Subject: Re: Nudge and money
>>
>> Thanks for prompting this exchange! I appreciate Adam's work on this
>> topic and think it is wonderful that you are discussing the normative
>> implications of nudge strategies in particular, and behavioral
>> economics generally. I have often had the same reaction as Tom
>> regarding "present bias" and so-called hyper-discounting. If the
>> extent to which we discount (at an individual or policy level) is
>> value choice, the democratic theorist in me would like to encourage an
>> explicit public deliberation about this. Indeed, if nudge strategies
>> are supposed to work at a subconscious level, I think it is
>> particularly important at the policy level to have debates about the
>> direction we are pushing. As Tom suggests, the application of some
>> nudge strategies seem to define behavior that deviates from the assumptions
>> of mainstream economics as a problem that needs to be solved.
>>
>> Michael
>>
>> ________________________________________
>> From: Anglo-American Health Policy Network [[log in to unmask]] on
>> behalf of Adam Oliver [[log in to unmask]]
>> Sent: Friday, April 12, 2013 9:21 AM
>> To: [log in to unmask]
>> Subject: Re: Nudge and money
>>
>> Dear Tom,
>>
>> Behavioural economists fall into many camps, which I agree is messy,
>> but there you go. I think you have summarised the position of one camp
>> - that is, they identify systematic patterns of behaviour that deviate
>> from the standard model, and consider these to be of descriptive
>> rather than normative import (probably most behavioural economists sit here).
>> Another camp believe that if the patterns are systematic, there must
>> be something deliberate about them and therefore how can we say they
>> are non-normative (i.e. that people should not behave in these ways).
>> We can say that they should not behave in these ways if people ought
>> to be expected utility maximisers, but many behavioural economists,
>> including me, do not believe that people necessarily ought to be EU
>> maximisers in all circumstances. Another camp of behavioural
>> economists recognise that the systematic patterns exist, but feel that
>> outcomes maximisation of any sort is too strong a position to take.
>> They'd rather just maximise opportunity of choice, warts (i.e. anomalies) an'
>> all.
>>
>> A fundamental problem, as I see it, with the area of nudge and
>> behavioural economics (loosely defined) is that many people who see
>> themselves as having expertise in this area, don't. I've been studying
>> behavioural economics since 1990, and I haven't mastered it by any
>> stretch of the imagination.
>>
>> You pose good questions, though.
>>
>> Best,
>> Adam
>>
>>
>>
>> -----Original Message-----
>> From: Anglo-American Health Policy Network
>> [mailto:[log in to unmask]] On Behalf Of Tom Foubister
>> Sent: 12 April 2013 14:09
>> To: [log in to unmask]
>> Subject: Re: Nudge and money
>>
>> Adam
>>
>> Suppose that mainstream economics rests on a model of individual
>> behaviour which fails to represent accurately, even adequately, how
>> people actually behave. I believe this is a presupposition of
>> behavioural economics.
>>
>> Behavioural economics, in contrast, takes how people actually behave
>> (using empirical observation and experiment to do so) as its practical
>> starting point.
>>
>> Like mainstream economics, behavioural economics rests on a pretty
>> stable model of the economic individual - attributes such as present
>> bias and so on being constants here. Being economics it has to.
>>
>> What I'm wondering is this:
>>
>> The way behavioural economics structures the economic individual is
>> essentially as a series of deviations from the mainstream economics
>> model, a series of 'falling-shorts', or errors - all negative
>> attributes given positive defining force by behavioural economics, and
>> for whose positive and enabling equivalents we have the mainstream model to
>> thank.
>>
>> So behavioural economics, at bottom, starts from, shares, reproduces
>> (in a shadow kind of way) and ultimately reinforces the mainstream
>> model. It certainly doesn't challenge it as a normative model. The key
>> difference is this: for mainstream economics the model reflects the
>> reality (even if individual economists don't quite fully believe
>> that); for policy-oriented behavioural economics reality needs to be
>> helped to better reflect the mainstream model.
>>
>> Perhaps the term 'present bias' itself says all that needs to be said.
>> To call it present 'bias' is automatically to consider it a flaw
>> relative to the un-flawed mainstream model, a model whose value is in
>> consequence affirmed. But I wonder if, for instance, a Buddhist would
>> see the 'bias' in it, or an Epicurean, or other worldviews.
>>
>> Are there any implications to this? Probably not, it's just a thought.
>> But I think we need to think carefully about the claim - implicit or
>> stated - behavioural economics makes to present a challenge to the
>> mainstream economics model; and we should also fully agree with you
>> that mainstream economists really oughtn't to be dismissive of
>> behavioural economics.
>>
>> Tom
>> -----Original Message-----
>> From: "Oliver,AJ" <[log in to unmask]>
>> Sender: Anglo-American Health Policy Network
>> <[log in to unmask]>
>> Date: Fri, 12 Apr 2013 11:32:36
>> To: <[log in to unmask]>
>> Reply-To: "Oliver,AJ" <[log in to unmask]>
>> Subject: Nudge and money
>>
>> Hi,
>>
>> If you are interested in the subject of paying people to make
>> healthier choices, I've written a very short blog on the subject,
>> relating it to
>> nudge:
>> http://blogs.lse.ac.uk/healthandsocialcare/2013/04/12/nudging-with-mon
>> ey
>> /
>>
>> Best,
>> Adam
>>
>>
>> Please access the attached hyperlink for an important electronic
>> communications disclaimer: http://lse.ac.uk/emailDisclaimer
>>
>> Please access the attached hyperlink for an important electronic
>> communications disclaimer: http://lse.ac.uk/emailDisclaimer
>>
>> Please access the attached hyperlink for an important electronic
>> communications disclaimer: http://lse.ac.uk/emailDisclaimer
>
> Please access the attached hyperlink for an important electronic
> communications disclaimer: http://lse.ac.uk/emailDisclaimer
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