Maybe not. Consider some of the puzzling data points that Robin discovered. To start with, people in developed countries consume way too much medicine—doctor visits, drugs, diagnostic tests, and so forth—well beyond what’s useful for staying healthy. Large randomized studies, for example, find that people given free healthcare consume a lot more medicine (relative to an unsubsidized control group), yet don’t end up noticeably healthier. Meanwhile, non-medical interventions—such as efforts to alleviate stress or improve diet, exercise, sleep, or air quality—have a much bigger apparent effect on health, and yet patients and policymakers are far less eager to pursue them. Patients are also easily satisfied with the appearance of good medical care, and show shockingly little interest in digging beneath the surface—for example, by getting second opinions or asking for outcome statistics from their doctors or hospitals. (One astonishing study found that only 8 percent of patients about to undergo a dangerous heart surgery were willing to pay $50 to learn the different death rates for that very surgery at nearby hospitals.) Finally, people spend exorbitantly on heroic end-of-life care even though cheap, palliative care is usually just as effective at prolonging life and even better at preserving quality of life. Altogether, these puzzles cast considerable doubt on the simple idea that medicine is strictly about health. To explain these and other puzzles, Robin took an approach unusual among health policy experts. He suggested that people might have other motives for buying medicine—motives beyond simply getting healthy—and that these motives are largely unconscious. On introspection, we see only the health motive, but when we step back and triangulate our motives from the outside, reverse-engineering them from our behaviors, a more interesting picture begins to develop. When a toddler stumbles and scrapes his knee, his mom bends down to give it a kiss. No actual healing takes place, and yet both parties appreciate the ritual. The toddler finds comfort in knowing his mom is there to help him, especially if something more serious were to happen. And the mother, for her part, is eager to show that she’s worthy of her son’s trust. This small, simple example shows how we might be programmed both to seek and give healthcare even when it isn’t medically useful. Robin’s hypothesis is that a similar transaction lurks within our modern medical system, except we don’t notice it because it’s masked by all the genuine healing that takes place. In other words, expensive medical care does heal us, but it’s simultaneously an elaborate adult version of “kiss the boo-boo.” In this transaction, the patient is assured of social support, while those who provide such support are hoping to buy a little slice of loyalty from the patient. And it’s not just doctors who are on the “kissing” or supportive side of the transaction, but everyone who helps the patient along the way: the spouse who insists on the doctor’s visit, the friend who watches the kids, the boss who’s lenient about work deadlines, and even the institutions, like employers and national governments, that sponsored the patient’s health insurance in the first place. Each of these parties is hoping for a bit of loyalty in exchange for their support. But the net result is that patients end up getting more medicine than they need strictly for their health. The conclusion is that medicine isn’t just about health—it’s also an exercise in conspicuous caring.
Sharing excerpts from a new book. This book talks about how our actions are driven by many hidden motives that we might not be aware of, and that over time, evolution has shaped our current behaviours to be able to live in social groups.
In this example, healthcare isn’t really just about fixing one’s health. There are social elements involved and for many other parties, it is also more about showing one cares than actually helping to deal with the illness in question. These are the sort of social norms and contracts that we have subconsciously developed over the pasts thousands of years.
