Our recent studies of medications labeled “natural” have yielded some interesting findings. First, most people prefer medications that are natural to medications that aren’t natural. Secondly, and perhaps most surprisingly, people do not see natural medications as being more effective than non-natural medications at attacking the disease at hand. So why do they prefer natural? It turns out that many people believe that natural medications have fewer unintended consequences in both short time and long term side effects. This stems from popular belief, sometimes called “caveman theory,” that our bodies are attuned for diets that were common thousands of years ago and thus might not react well to newer, synthetic products. Hopefully new, exciting research will shed light on the consequences, both positive and negative, of these beliefs.

Here is a letter I recently got from a reader:

How to remind a child to take his medication?

Dear Dan,

My son has Type I diabetes. He is constantly forgetting to check his blood sugar level and inject insulin when he needs it, and I am forced to remind him every couple of hours. I hate to nag him, and know it doesn’t help him become more independent. On the other hand, if he keeps forgetting he could become severely ill. What should we do?

Tal

Dear Tal,

It is often hard to remember to take medication, especially when you hardly feel the severity of the illness or the relief of the medication. On the other hand, no one forgets to take heartburn medication – you’ll probably sprint for it as soon as heartburn begins to set in. With asthma and other inflictions that require more preventative measures, forgetting to take your medication will exacerbate symptoms and eventually lead to greater consequences. But until this critical point, there is no definitive moment where long-term preventative medication clearly needs to be taken. If you have an asthma attack, you can always pull out your inhaler. Similarly, diabetes does not cause chronic excruciating pain and won’t remind you to take your medication.

As for reminding your son, you might not have a choice. No one wants to monitor glucose levels all day, and he may need reminders to do so. But the reminders can and should come from his environment, as well as from habits you and your son can create together. Rather than reminding him every few hours yourself, create a mechanism that will remind him automatically.

Several doctors whom I’ve talked to told me that they recommend patients who need to take medications twice a day to put it next to their toothbrush. This way, this new habit is combined with the existing habit of brushing your teeth. But if you need to take your medication more than twice a day, the toothbrush will not be enough.

So the question is what regular activity can be tied to your son’s medications? Can you do something that is connected to his meals, or that is connected to other desires or hobbies? Can you set an electronic reminder in his cell phone? Once he has established a habit of checking his blood sugar, he may not even need these reminders anymore – but they can help build this habit until it takes on a life of its own.

It is also important that your son have a way to tell you that he has taken his medication without asking him. For example, you can make a board that he can mark when he checks his blood sugar and when he takes the insulin, or a designated can to put the used syringes. He could even upload this information to the internet – there is probably an app for that. If you are creative, you can find the right solution for you and your son with minimal effort.

A fascinating new study just came out, showing that tears that were produced by women under negative emotions reduce the sex drive of men!  This gives men yet another reason not to upset women.

Here is the abstract:

Emotional tearing is a poorly understood behavior that is considered uniquely human. In mice, tears serve as a chemosignal. We therefore hypothesized that human tears may similarly serve a chemosignaling function. We found that merely sniffing negative-emotion-related odorless tears obtained from women donors, induced reductions in sexual appeal attributed by men to pictures of women’s faces. Moreover, after sniffing such tears, men experienced reduced self-rated sexual arousal, reduced physiological measures of arousal, and reduced levels of testosterone. Finally, functional magnetic resonance imaging revealed that sniffing women’s tears selectively reduced activity in brain-substrates of sexual arousal in men.

The full paper is here:

Michael Jackson died of cardiac arrest on June 25, 2009. Recently, a hearing started regarding his former personal physician Conrad Murray.  In this hearing the physician is accused of involuntary manslaughter, negligence, and administration of a dangerous and unnecessary cocktail of medications that accelerated the superstar’s death.

While I won’t argue for the physician’s innocence, I do think we should ask – how common is the tendency to prescribe patients what they want? Is this a singular incident, a case of a drug-pushing “bad apple,” or could there be more general forces at play?

What I hear from my physician friends is that they feel tremendous pressure to please their patients, and they know that if they don’t give them what they want, some other physician will (or at least this is how they justify their overprescription).

A common case of this sort is the case of the influenza virus. When patients contract the flu, they go to their doctors, feeling miserable and begging for help. Doctors know that they shouldn’t prescribe anything for their viral patients (and that the best thing to do is nothing), but they feel a pressure to give the patients something as they walk out the door. And so, they prescribe antibiotics, which don’t treat the flu but do build up drug-resistant bacteria that may cause trouble in the future.

Doctors in this situation face a conflict of interest, between what the patient wants from them, what is good for their own wallet (to keep the patient happy), and what is the right medical thing to do.  Moreover, the situation is not perfectly clear because while it is unlikely that the patient has a bacterial infection (one where antibiotics could help) it is still possible – creating a gray zone of medical practice.

The thing about medical gray zones is that they become grayer, more blurred, when patients are more powerful or high-profile. The minute a doctor has a patient like Michael Jackson who is wealthy and used to getting his way, the pressure to succumb has to be much higher.

In thinking about Michael Jackson’s physician, consider this. It’s easy to find someone guilty and lay the blame solely on that individual, one man who shamefully deviated from the standard of care, but it’s much more challenging to put ourselves in his position and think about what we would have done if we were in his position. I suspect we too would have prescribed those meds.

P.S. I can’t believe that I am writing a blog about Michael Jackson

A couple months ago, I wrote about a study showing that those who had experienced a little (but not too much) adversity were better at handling physical pain than their pain-free counterparts.

Now, a new study finds the same trend – but with mental health and wellbeing. It seems that both physical and mental resilience can be achieved through a healthy amount of adversity. When we face hard times, we adapt and build a callous that helps us take on future challenges.

Resilience is often considered a process that occurs in spite of adversity, but we might want to instead think of it as a phenomenon that appears because of adversity.  Indeed, we can become even more physically and mentally capable as a result of our misfortunes.

On October 5^th I appeared on NPR, discussing some of the problems with dentistry.

This was not the first time that I have pointed to problems of conflicts of interests.  In the past I have been vocal about conflicts of interests in Medicine and in Banking, but somehow this time I stuck a nerve and as a consequence I got lots of angry emails (see also the comments on NPR).

The basic email I got had the following form:

“Dan, you are an idiot.  I am a dedicated dentist who only does what is in the best interest of my clients.  But, it is true that there are a few bad apples in dentistry, as they are everywhere”

One of the responses came was from Ronald Tankersley, D.D.S. the President of the American Dental Association.  Among other things Ronald Tankersley writes:

Ariely’s assertion that patients stay with their dentists because pain, discomfort and having to “keep your mouth open” causes cognitive dissonance is pure nonsense— he sounds like someone who hasn’t visited a dentist for decades. Modern pain and anxiety control techniques have all but eliminated the discomfort that older patients may have encountered as children. In fact, younger patients today don’t think of dental care as being uncomfortable at all, partly because they rarely get disease and partly because the treatment they do get is rarely uncomfortable.

Particular details of the comments aside, I would like to take this opportunity and clarify my position on the pay-for-service model that we commonly use in dentistry and its effects on conflicts of interests (dentists that get paid for X want to do X), and on the quality of care:

1)   I don’t think that dentists are particularly evil, selfish, of greedy just that (much like the rest of us) when they face conflicts of interest they are likely to see the world in a distorted way.  They are likely to look, and find, problems that the treatments for are ore lucrative.  The same of course applies to bankers, MDs, financial advisors, expert witnesses, etc.

2)   The evidence for conflicts of interests is rather staggering, and I suspect that the majority of dentists would agree with me that this is a problem that is hurting their clients and in the long-terms also their profession.

3)   One of the hallmarks of conflicts of interests is that people don’t see themselves as being influenced by such forces (“I am always doing the right thing, other people succumb to conflicts of interests…”)

4)   I am easily influenced by data, and I would read carefully any study or data that would add to my understanding of this problem – so if you have such data, please send it my way.

5)   Rather than dismissing the problem completely, perhaps the American Dental Association should take this as an opportunity to study the standards of care and conflicts of interests in dentistry.  On my part, I am willing to help in any way I can.  I can help design studies, analyze data, propose ways to eliminate conflicts of interest and get patients to seek second opinion, etc.

It is easy to pretend that world of dentistry is working just fine, and that the error is entirely mine, but I suspect that this is not the right approach for patients, for dentists, or for the American Dental Association.

Irrationally yours

Dan Ariely

A few weeks ago we conducted an online study on this question (the link to the survey was the “Click to participate” on the right side of the screen), and I wanted to thank the participants and tell you a bit about what we found.

In this study all the participants viewed a potentially funny video involving an individual who would seem to have “issues.” (http://www.youtube.com/watch?v=-Sd-j0rKeKw) The video clip showed a college student getting upset in an arguably overdramatic fashion after she got in trouble for inadvertently setting off her sorority house’s fire alarm by using the house’s fire extinguisher just for fun. Her friend apparently found it amusing enough to post it on youtube, and the clip has received millions of views since then.

The study had three groups: The first one was not given any additional information regarding the person.  A second group was told that this person had suffered from stress since childhood.  The third group were told that the person student in the clip had suffered from OCD since childhood.

What we found was that participants who were told that the girl had suffered from OCD since childhood found the clip less funny, laughed out loud from it less, and were less likely to recommend it to others than other participants. They also felt worse for the student and thought she deserved a smaller fine for inadvertently setting off the sorority house’s fire alarm than if they were either told beforehand that the student had suffered from stress since childhood (or received no justification at all). Participants who were told she had OCD also thought she seemed more likeable, intelligent, and creative. But they also thought that she seemed like a bigger loner and more antisocial.

What I think this means (and we need more research on this) is that giving individuals a disorder-label causes others viewing them to place the blame on the disorder and not on the person.  Think for example about a parent who is told that their kid has ADHD – would this parent blame themselves less than if they were told that their kid is an active difficult kid?  I think the answer is yes, and maybe this is one of the reasons that we as a society seem to be obsessed with diagnostic labels (other reasons include incentives for psychologists, medical companies etc).

By the way, did I tell you that I have a Restless Hand Syndrome”?

Irrationally yours

Dan

I personally find fruit and vegetables to be not only healthy, but also delicious. I enjoy cooking and preparing them, and try to eat them often. Sometimes I wind up spending egregious amounts of money getting the freshest local organic produce. Still, even when I empty my wallet at the farmer’s market, some of my fruit and veggies inevitably end up wilting or rotting in the fridge, leaving a fairly unpleasant sludge. A number of things could contribute to this waste – but I’d like to point out a few simple design flaws that I think we can fix.

1) I suspect that one of the main culprits is the produce drawer in the refrigerator.  Most refrigerators have a special drawer designed to hold produce, usually located at the bottom of the fridge.  The drawer is often just barely opaque and for some reason difficult to open. Because of these “features,” when you open the fridge door, you look straight ahead, to the leftover lasagna or apple pie (and their convenient position) come to mind, leaving the carrots and nectarines hidden and forgotten in the vegetable drawer.  If the design of the produce drawer is one of the barriers for eating the fruit and vegetables we have already purchased, what can we do about it?  For one, instead of using the crisper to store fruit and vegetables, we could put them on a higher shelf so that they are more inviting when that door is opened. We’ll smile and say to ourselves: “oh, right, I now remember I have blueberries and I want to eat some of them.”

2) Another obstacle that keeps us from eating our vegetables before they’ve gone rancid is the sense of immediacy and gnawing hunger that compels us to open the fridge in the first place. We usually go to the fridge when we are already hungry, and are looking for something to pop in our mouths right away. Because there are usually a few steps between raw vegetables and ready to eat food, we shy away from them in favor of something faster and more convenient. One way to solve this would be to wash, cut or cook them in advance so that they are already prepared at the pivotal moment of hunger.

3) In addition, these perishables don’t come with any indication of an expiration date. Until we discover the point-of-no-return, it is hard to tell how far the produce are from the end of their useful lives. We know that when we buy fish, we should eat it within the next couple of days. With milk, there is a date stamped right on the container, undisputable and in plain sight. Because we are averse to losing money (even money already spent), these expiration dates compel us to make sure that we use that pound of Mahi Mahi, eat that yogurt, and finish the milk. By leaving the produce’s expiration date ambiguous, it is hard for us to plan when to eat our produce, and we often discover that we have missed the expiration date after it’s too late. If we were to make our own expiration dates and stick them on our celery sticks, we would be more likely to use them before they’ve turned into a mushy mess.

This type of waste worries me because I think that it also prevents us from future purchases of fruit and vegetables. Imagine this scenario: You buy a bag of grapes for $7.50, throw them in the crisper drawer, and forget about them. A couple weeks later, you open the crisper on a whim and are alarmed to find that the former bag of grapes has now turned into a moldy pile of muck. You feel awful, not only because you have to clean up the mess, but because you paid seven dollars and fifty cents for this. You grumpily go for the sponge and think to yourself, “Well, I’ll never do that again.”

My general point is this: There are all kinds of reasons why we eat badly, but some are more fixable than others if we only look at our behavior and undercover the nuanced forces guiding our actions. Instead of throwing the bag of grapes into the dark drawer in the bottom of the fridge, we can save that drawer for the cupcakes and instead put some grapes in a tray on the top shelf with some mixed greens and pecans, ready to grab and go. The rest of the grapes can be prewashed and stamped with a homemade expiration sticker. If we make plans to eat them within a few days and mark them as such, we are more likely to stick to our goals. This way, we can eat more fruit and veggies and avoid wasting money or creating a mess – benefits all around!

Irrationally yours

Dan

What would you think if someone told you: Do the right thing because your life may depend on it. Or more accurately, that you better start making better decisions because it is a matter of life and death. This may sound like something an overprotective parent would tell their child) but in reality it’s the way most of us should start to think about our day to day decisions and their potential to lead to harmful habits and fatal consequences. It is hard to believe that this is true, but recently, researchers have done some interesting analysis on this topic and the results support the idea that personal decisions, and often fairly mundane ones, are a leading cause of premature death in the United States (and I suspect that similar numbers are also the reality in the rest of the developed world).

One of the most interesting analyses on the ways in which our decisions kill us is one by Ralph Keeney (Operation Research, 2008), where Ralph puts forth the claim that 44.5% of all premature deaths in the US result from personal decisions – decisions that involving among others smoking, not exercising, criminality, drug and alcohol use, and unsafe sexual behavior.  In his analysis Ralph carefully defines the nature of both the type of personal decision and what is considered premature death. For instance, dying prematurely in a car accident caused by a drunk driver is not considered premature in this framework because the decision to drive somewhere is not one that can logically be connected to the premature death. Unless, of course, the person who dies is also the drunk driver, in which case this counts as a premature death caused by bad personal decisions.  This is because the decision to drive drunk, and dying as a result, are clearly connected.  In this way you can examine a large set of cases where multiple decision paths are available (the drunk driver also has the option to take a cab, ride with a designated driver, or call a friend), and where these other decision paths are not chosen despite the fact that they won’t directly result in the same negative outcome (i.e fatality). As other types of examples, consider the decisions to smoke (when not smoking is an option), to overeat (when watching our weight is an option), or for people with long term medical conditions to skip taking insulin or asthma medication when these are important to their ongoing health.

Using the same method to examine causes of death in 1900, Keeney finds that during this time only around 10% of premature deaths were caused by personal decisions. Compared to our current 44.5% of premature deaths caused by personal decisions, it seems that on this measure of making decisions that kill ourselves we have “improved” (of course this means that we actually got much worse) dramatically over the years.  And no, this is not because we’ve become a nation of binge-drinking, murderous smokers, it’s largely because the causes of death, like tuberculosis and pneumonia (the most common causes of death in the early 20^th century) are far more rare these days, and the temptation and our ability to make erroneous decisions (think about driving while texting) has increased dramatically.

What this analysis means is that instead of relying on external factors to keep us alive and healthy for longer, we can (and must) learn to rely on our decision-making skills in order to reduce the number of dumb and costly mistakes that we make.

The question then becomes how to help people become better decision-makers. Or at least better at making decisions where their health is concerned. If nearly half of premature deaths in the US can be avoided by making better decisions, it is clear to me that it would be worthwhile to spend much more time and effort to disseminate the knowledge we have gained in social science about the main ways in which people fail to make good decisions.  It is of course over-optimistic to expect that just helping people to see what mistakes they are likely to make will fix the problem, but personally I would be happy even if it only slightly reduced the number of catastrophic decisions.  The next step we need to take is to expand upon the research that examines what kind of methods encourage healthier decision-making and conduct much more research in areas that could help us limit our mistakes. For example, based on research about how people make different decisions when they are sexually aroused we might concentrate on providing comprehensive sexual education that teaches teenagers how to make decisions while in the heat of the moment.  Similarly, by understanding how people think we might be able to teach people to enjoy eating fruit and vegetables; how to make exercise part of their ongoing lifestyle; and develop effective smoking cessation programs. And it would also help to remember, in light of this, that every decision counts.

A few months ago I attended a conference held by the American Council for an Energy-Efficient Economy. One of the interesting things they noted this year was about their lunch offering.

You might be surprised to know that meat production, between raising, processing, packaging, and preserving meat uses a lot of energy. In fact, Michael Pollan, author of The Omivore’s Dilemma once asserted that “A vegan in a Hummer has a lighter carbon footprint than a beef eater in a Prius” (it turns out that this was a bit of an exaggeration).

If you’ll note in the picture below, it seems that in this meeting (2009) the council was able to convince attendees to switch to a vegetarian lunch.

The trick, as I’ve blogged about before, was making the vegetarian option the default option! For the past two years, the council did not have any default and the vast majority of the attendants picked the meat option. This year they set up the vegetarian option as the default, and this yielded a more environmentally friendly results, with a mere 20 percent insisting on having their steaks (see the column for 2009).

The other good news is that the vegetarian option was also (in this case) more tasty and healthy.