We’re Screwed

Via LessWrong, a very disturbing study. Details in this NYT article but here’s the lowdown:

A huge problem in medicine is patients not taking their medication properly, usually by forgetting to take it. Up to a third of all US patients do not comply with their schedule and this causes untold hospitalisations, problems and deaths.

Researchers have done a study which tried to bribe patients with small cash payments for compliance by enrolling them in a lottery. By taking your medication daily you go into a daily lottery to win $10-$100 per day. The results of the study have been positive.

Before the program, Chiquita Parker, a 25-year-old single mother with lupus, too ill to continue her job with special needs children, repeatedly made medication mistakes, although she knows she depends on warfarin to prevent clots than can cause strokes, paralysis, or death.

“I would forget to take it,� and feel “like I couldn’t breathe,� she said. Or she would “take two in a day,� and develop bruises from uncontrolled internal bleeding.

But in the six-month lottery program, she pocketed about $300. “You got something for taking it,� Ms. Parker said. Suddenly, she said, “I was taking it regularly, I was doing so good.�

So just to get this straight: for a huge proportion of people, the fact that a drug will prevent bloodclots, strokes or death is not salient enough to remember to take it daily. But winning a small store gift card (which one patient spent on “soap, tissues, chips”) is. And these seem to be regular people not some statistical minority.

Of course it’s easy to see some of the potential reasons. For instance, taking your medicine is a reminder of the fact that you are sick — it’s understandable that for a lot of people there will be a subconscious avoidance of anything that is associated with a disease. Especially diseases carrying a stigma like mental illnesses.

Still, bottom line is that to our brains, a $20 gift card is more important than life itself.

In the words of Brian Dunning: we’re screwed!