Risk literacy and Reduced Healthcare Costs - Joe Abittan

Risk Literacy & Reduced Healthcare Costs

Gerd Gigerenzer argues that risk literacy and reduced healthcare costs go together in his book Risk Savvy. By increasing risk literacy we will help both doctors and patients better understand how behaviors contribute to overall health, how screenings may or may not reveal dangerous medical conditions, and whether medications will or will not make a difference for an individual’s long-term well being. Having both doctors and patients better understand and better discuss the risks and benefits of procedures, drugs, and lifestyle changes can help us use our healthcare resources more wisely, ultimately bringing costs down.
Gigerenzer argues that much of the modern healthcare system, not just the US system but the global healthcare system, has been designed to sell more drugs and more technology. Increasing the number of people using medications, getting more doctors to order more tests with new high-tech diagnostic machines, and driving more procedures became more of a goal than actually helping to improve people’s health. Globally, health and the quality of healthcare has improved, but healthcare is often criticized as a low productivity sector, with relatively low gains in health or efficiency for the investments we make.
I don’t know that I am cynical enough to accept all of Gigerenzer’s argument at face value, but the story of opioids, the fact that we invest much larger sums of money in cancer research versus parasitic disease research, and the ubiquitous use of MRIs in our healthcare landscape do favor Gigerenzer’s argument. There hasn’t been as much focus on improving doctor and patient statistical reasoning, and we haven’t put forward the same effort and funding to remove lead from public parks compared to the funding put forward for cancer treatments. We see medicine as treating diseases after they have popped up with fancy new technologies and drugs. We don’t see medicine as improving risk and health literacy or as helping improve the environment before people get sick.
This poor vision of healthcare that we have lived with for so long, Gigerenzer goes on to argue, has blinded us to the real possibilities within healthcare. Gigerenzer writes, “calls for better health care have been usually countered by claims that this implies one of two alternatives, which nobody wants: raising taxes or rationing care. I argue that there is a third option: by promoting health literacy of doctors and patients, we can get better care for less money.”
Improving risk and health literacy means that doctors can better understand and better communicate which medications, which tests, and which procedures  are most likely to help patients. It will also help patients better understand why certain recommendations have been made and will help them push back against the feeling that they always need the newest drugs, the most cutting edge surgery, and the most expensive diagnostic screenings. Regardless of whether we raise taxes or try to ration care, we have to help people truly understand their options in new ways that incorporate tools to improve risk literacy and reduce healthcare costs. By better understanding the system, our own care, and our systemic health, we can better utilize our healthcare resources, and hopefully bring down costs by moving our spending into higher productivity healthcare spaces.
Living Under Constraints

Living Under Constraints

In Letters From a Stoic, Seneca quotes Epicurus in writing, “It is wrong to live under constraint; but no man is constrained to live under constraint.”

 

Quite frankly, Seneca and Epicurus are wrong. The stoic thinkers make two arguments in the short quote, and both fail to live up to the reality of humankind’s existence. The sentiment shared is noble, and certainly rings true in my American ears, but on closer reflection, proves to be a fiction.

 

The first argument, that it is wrong to live under constraint assumes that human beings can somehow exist separate from society with all needs and desires fulfilled. Stoic thought focuses on our mind and what is within our direct control. Stoicism hinges on the idea that our thoughts and reactions are the only thing we can possibly have true ownership and control over. It encourages us to move beyond our ego, which drives us to acquire possessions, build a reputation, and always bolster our social status with things beyond our control. Stoic philosophy encourages self-awareness and a sense of self-contentedness that comes from controlling one’s mind and being satisfied by simply experiencing life, whatever life is presented to us.

 

However, having constraints in our lives is important, and might actually be better for us than unlimited choice and possibility. A famous study on jam selection and satisfaction from 2000 suggests that people who had a limited selection of jams were more satisfied with their selection than people who picked a jam from a more broad and expansive selection of jams. With unlimited choice, options, and opportunities, we are unhappy. We can’t make a selection when we are not living under constraints, and we are constantly unsure if we truly made the best choice when our choices are unlimited. Constraints play a powerful role in helping us understand who we are, where we fit in society, and by creating bounds for our decisions, actions, and lives. Without constraints, we do not always flourish, sometimes we flounder.

 

What we see is that our lives are guided by and defined by constraints. Therefore, the second argument of the two stoics, that no man is constrained to live under constraints, is clearly wrong. We might not be actively constrained by another human being, but we are constrained by our governments, our home owners associations, or our bosses or customers. We are also constrained by nature and our physiology. There is a limit to how fast we can run, what forces our bodies can endure, and much we can eat. Our brains are incredible machines, but they too are limited in how long they can operate without sleep, how difficult of tasks they can work through, and how much they can remember. There is simply no way to escape constraints, and living in a complete freedom, as Seneca seems to be suggesting with the rest of his letter after the quote above, will not lead to unbridled happiness. It is constraint, and how we learn to live within constraints, which brings forth our creativity, our imagination, and makes life actually possible.
Limits in What We Do

Do We Need Some Type of Limit?

I’ve recently watched The Hobbit trilogy, and images of Tolkien’s dwarf kings consumed with greed and gold have stuck with me. For whatever reason, the image of King Thror spinning around in a state of dazed confusion among his treasure, and the image of Thorin becoming corrupted by the same gold bounty have replayed through my mind. Tolkien and the artistic creators of The Hobbit are using the dwarf kings to show the negatives of greed, of lust for power, and the danger in pursuing wealth over people and relationships. They also show what can go wrong in the mind when we have everything.

 

The Hobbit came back to mind as I looked over quotes I highlighted and notes I took in Dreamland by Sam Quinones. My last two posts were about our efforts to avoid pain, suffering, and negativity and about how we try to fill our lives with consumer products that promise to make us happy. Mixed in with those ideas, Quinones adds, “man’s decay has always begun as soon as he has it all, and is free of friction, pain, and the deprivation that temper his behavior.”

 

Thror and Thorin show us what Quinones means. When the kings were at the top, when there were no constraints in their power or wealth, they used other people for their own gain. Their minds turned to selfish impulses, and turned away from doing what was right for the good of their people. When they reached the top, they atrophied, with nothing to work toward but the preservation of their own grandeur.

 

A curious phenomenon that Quinones highlights throughout his book is how opioid addiction cuts across all socioeconomic status levels. The sons and daughters of esteemed judges and doctors just as well as men and women who have grown up in poverty all seem to be victims of opioid addiction. For some reason we expect addiction among the second group, but find it inconceivable that the first group might face the same challenges. In some ways, the quote above from Quinones answers part of why we see addiction among middle class families and among the children of talented professionals.

 

When we have no limits in what we do, when our lives are tailored, curated, but isolated, we begin to lack purpose. Our lives might look full from the outside, but be void on the inside. When we seem to have it all, the value of our lives can decay, and without friction under our feet to push us forward, we can’t move anywhere. Just as our excesses produce terrible externalities, our having it all, or at least thinking we can buy it all, produces a feeling of purposeless that can lead to drug use to blunt the meaninglessness of self-indulgence.

 

My recommendation is to remember Thorin and his grandfather. To remember that our selfish desires can become our own downfalls, and to turn instead toward community building and relationships with others. To strive for our own greatness will leave us on an empty throne, but to work with others for shared goals will help us develop real structures in our lives that last and have real value.