Tuesday, April 02, 2013

Excited About Nudging?

A reasonably recent fad in public health is the idea of nudging folks to do the right - ie healthy - thing. The idea is basically that you incentivize people to live healthy. Whether such a strategy can work over time probably depends on a whole range of factors, so I'm not here to pass judgment on 'nudging' as such.

What annoys me is lousy reporting (and arguably pointless social science research) in the service of the nudging agenda. The New York Times, one of my preferred daily reads, recently reported about a study involving Mexican gay men at high risk for HIV infection.

The Times tweeted the findings of this study like this, 'Gay Men in Mexico City Would Stay HIV Free for $288, Study Shows'. The study, of course, found nothing of that sort! And that is what annoys me. 

All that the eager social scientists discovered was that gay men they interviewed in Mexico City said they would 'pledge to stay H.I.V.-free, attend a monthly safe-sex talk and take regular H.I.V. tests to prove they were uninfected — all in return for just $288 a year.' That is a far cry from actually staying HIV negative, as the Times tweet misleadingly summarizes. 

Imagine the excitement of our public health people! It costs about 8000 $ to treat HIV-infected folks per year, so getting that deal at 288 $  per year is a bargain, isn't it? 

 Well, what's the catch then: For starters, just because people promise to stay HIV negative doesn't mean they actually will stay HIV negative. Surely living a healthy life instead of going on life-preserving chemotherapy is a better incentive than 288 $ per year! The thing about safe sex is that it requires a tad bit more to succeed than 288$ per year, something that seems to have escaped our social science nudgers. It doesn't seem terribly sensible to base any public policy in this context on such research. It might be possible to get people to test more frequently for HIV, and to pop more frequently into clinics, but it seems far fetched to suggest that a measly 288$ per years would impact greatly on actual sexual behaviours. Answers to hypothetical questions with $$ signs attached to them don't quite cut it, at least in my view. It's one thing to say the right thing in response to a hypothetical question, it's quite another to actually live up to what one's answer suggests one would do if it came to the crunch.

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