NDRC’s Fergus O’Dea wonders if technology can change people’s attitude to their health and wellness.
A major theme in modern healthcare is the improvement of patient adherence to therapeutic (drug) and behavioural (diet, exercise) regimens prescribed by their physicians.
Behavioural change is one of the most difficult and underestimated factors in improving outcomes, particularly in chronic diseases. I’m an advocate for evidence-based medicine, but to assume that scientific evidence, or even the recommendation of a doctor, will be sufficient to ensure a patient will automatically and faithfully adopt a particular course of action is naive.
We ought not think of patients as rational agents or, as an economist would say, homo economicus. People are rationalising rather than rational, and the most effective interventions are those designed from a behavioural economics standpoint.
On this theme, I’d like to propose some common cognitive biases and how they impact on people’s attitude to health and wellness.
Dynamic inconsistency: A tendency to favour the now over the future. This bias causes us to choose hedonistic behaviours that might have longer-term health implications. ‘Okay, one more. But the diet starts Monday.’
Base rate fallacy: 1 in 2 smokers die of a tobacco-related illness, but smokers sometimes offer their other, healthier behaviours as mitigation. These might move the dial a little on an individual’s risk, but not as much as someone experiencing base rate fallacy might expect. ‘Yes I smoke the occasional cigarette, but I eat healthily and I don’t drink.’
Confirmation bias: We tend to ignore information that contradicts existing beliefs and instead latch on to examples that confirm our point of view, even if these are the exception rather than the rule. ‘She smoked 60 cigarettes a day and lived to 90 years of age.’
Availability cascade: This is where repetition lends credence to a theory, even in the face of strong evidence to the contrary. See the birther movement, climate change denial and the alleged, but non-existent, link between vaccinations and autism. ‘There’s no smoke without fire.’
Illusory correlation: Post hoc ergo propter hoc – if something happened before another, it must have been the cause. We seek a remedy when our symptoms are at their worst. In many cases, these things tend to resolve themselves without medical input (regression towards the mean), which can be misunderstood. ‘I got a homeopathic remedy and it cleared my migraine up straight away.’
Availability bias: We overestimate the risk associated with things where consequences are easily brought to mind or illicit an emotional response rather than those things that are statistically more dangerous. Therefore, people are afraid of flying, because a plane crash is dramatic and is often depicted in popular culture, but it is far less risky than more mundane hazards, like sedentary lifestyle. ‘I’ve been drinking poitín for years. Never did me any harm.’
The next generation of healthcare innovations will need to empower patients to make meaningful changes in their behaviour and will need to address some of these biases.
The trick is to create interventions that patients want to use rather than ones they feel they have to use. Bosch had early attempts at this on the Health Buddy platform where patients were asked trivia questions to increase engagement and stickiness. Fitbit create great consumer products that promote healthy behaviours without the guilt trip. And, of course, there’s the stunning success of Pokémon Go – perhaps the best example of making exercise more fun and social.
By Fergus O’Dea
Fergus O’Dea is a venture investment leader at NDRC who, prior to this role, held various positions in industry including commercial manager at ResMed and senior scientist at Pfizer Biotech. O’Dea holds a master’s in biopharmaceutical engineering and an MBA from University College Dublin.
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