The economist, Richard Thaler, has just been awarded a Nobel Prize for his work in what has come to be called Nudge Theory.
The impetus behind Nudge Theory was a problem with the discipline of economics in general. The basic theories of economics were built on the idea that people broadly act in their own self-interest.
Yet we clearly don’t. Sometimes we’re simply altruistic (to our children, for example). Sometimes we don’t have full information available (e.g. when we buy terrible financial products). And sometimes we’re even capable of self-deception (not changing our diets until we get diabetes).
Much of the activity in modern economic theory – and much of Thaler’s work – has been in aligning economics with psychology, to better map out what people are likely to do in a particular situation.
One result has been Nudge Theory, the idea that very subtle changes to government policy; not necessarily the traditional carrots of financial incentives or the sticks of tax or legal sanction; can encourage us to do the right thing. Thaler said: “By knowing how people think, we can make it easier for them to choose what is best for them, their families and society,”
This is clearly something that has been missing in healthcare, and particularly healthcare technology.
Back in 2011, I worked with an e-learning business in healthcare. We were partnered with a major diabetes medication brand with a view to improving programme adherence. The plan was to design a fairly omni-present e-learning course which would help diabetes patients understand their condition and maintain drug adherence more effectively.
As part of my role, I interviewed both diabetes specialists and patients. I found myself in a ward on the South Coast speaking to a charming lady who was about to have her leg amputated. “Oooh”, she said. “It’s not nice of course, but I do love my snacks”.
And that was the day that I realised that while technology is fabulous, human motivation is much more powerful.
You want more examples? Take a look at the share price of Fitbit – the doyen of personal trackers. It’s worth one quarter of its peak value. Sure, that’s partly because smartphones have replicated much of these devices’ functionality.
But it’s also because personal trackers don’t ultimately help most people get fitter or lose weight. The lead researcher of one report from the University of Pittsburgh in the US said: "People have a tendency to use gadgets like these for a while and then lose interest with time as the novelty wears off.” In other words, just as with my e-learning plan for diabetics, technology doesn’t make it easier to stick to the programme.
And then check out this recent damning report from the University of Wisconsin, which found that telehealth systems actually increase patient office visits and show no discernible improvement in health outcomes. The researchers say “The problem is that healthcare is much more complicated [than routine questions] - patients may overreact to minor symptoms or not be clear enough in describing their situation and that leads to doctors feeling obligated to schedule an office visit.”
This is not quite the same as patients failing to help themselves; but it is another example of technology failing to deliver value because it fails to account for the infinitely human aspects of healthcare – in this case the pure value of contact, of speaking eye-to-eye, and the worry of physicians themselves that they might not have done a thorough job.
From all these examples, you might think that the future of healthtech is bleak. I don’t think so – in fact, I think it is unstoppable. If nothing else, it is the only way we will care for an aging population with ever more complex needs in a commercially viable way. But we will need to account for human frailty and the psychology of patients.
Healthtech needs its nudges.