Spend some time with the Society for Medical Decision Making, and “shared decisions” starts to seem less a clinical ideal and more an offshoot of picking a monthly cell phone plan. The fine line between “motivating” and “manipulating” behavior (albeit sometimes unintentionally) starts to blur.
At the group’s recent annual meeting in Chicago, the differing sensibilities of medical and marketplace ethics were in plain view on a panel entitled (with a nod to the Richard Thaler and Cass Sunstein behavioral economics best-seller), “From a Nudge to a Shove: How Big a Role for Shared Decision Making?”
Peter Ubel, a physician and a professor of marketing and public policy at Duke University, told how some free-market theorists have defined away, “overweight.” Since people know what causes them to put on pounds, goes this reasoning, the weight they are must be the weight they rationally decided to be. (Shades of Dr. Pangloss!)
Unfortunately, eating decisions are not purely rational. Eat in a large group, said Ubel, and lingering at lunch could boost your calorie count by 25 percent. Choose the large plate at the buffet table over the small one and bump up calories another 25 percent. Our brains even seek out the bad: give us two identical crackers, but label one as having a more “unhealthy fat,” and we’ll consistently pick it over the healthier-labeled cracker in a taste test.