Don’t Nudge Me: The Limits of Behavioral Economics in Medicine
A more recent Cochrane review concluded that “current methods of improving medication
adherence for chronic health problems are mostly complex and not very effective.”
At first glance, behavioral economics — the basis of Richard Thaler’s recent
Nobel Prize in Economics — seems like a rich field of potential solutions.
Those patients who took their drugs were entered into a lottery in which they had a 20 percent chance to receive $5
and a 1 percent chance to win $50 every day for a year.
A thorough review published in The New England Journal of Medicine about a decade ago estimated
that up to two-thirds of medication-related hospital admissions in the United States were because of noncompliance, at a cost of about $100 billion a year.
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Whenever I talk to physicians about outcomes that are worse than you’d expect, they are quick to point out
that noncompliance — when a patient does not follow a course of treatment — is a major problem.
The lottery group members could also sign up to have a friend or family member automatically
be notified if they didn’t take their pills so that they could receive social support.
A systematic review published five years ago in Annals of Internal Medicine looked at all kinds of trials that tried to improve patient compliance.