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TED英文演讲:如何利用“非理性”,改善不健康行为?
我们为什么要做出明知道对健康不利的错误决定?在这场坦率且有趣的演讲中,行为经济学家和健康政策专家David Asch解释了为什么我们的行为常常是——以一种高度可预测的方式——非理性的,并且展示了我们如何能掌控这种非理性,从而做出更好的决定,并在整体上改善我们的医疗保健系统。
演讲者:David Asch行为经济学家,卫生政策专家,通过改善医生和患者在医疗保健和日常生活中做出决定的方式,促进了个人和人群的健康。https://v.qq.com/txp/iframe/player.html?width=500&height=375&auto=0&vid=q3052q6bdkr
It's April of 2007, and Jon Corzine, the Governor of New Jersey, is in this horrific car accident. He's in the right front passenger seat of this SUV when it crashes on the Garden State Parkway. He's transported to a New Jersey trauma center with multiple broken bones and multiple lacerations.
那是 2007 年的 4 月,新泽西州的州长,荣·科赞(Jon Corzine),陷入了一场可怕的车祸。当他乘坐的那辆 SUV 在花园州高速公路撞毁的时候,他正坐在副驾驶的座位上。他被转移到一家新泽西的创伤治疗中心,身上伴有多处骨折和撕裂。Now, before Corzine was Governor of New Jersey, he was the US Senator from New Jersey, and before that, he was the CEO of Goldman Sachs, responsible for taking Goldman Sachs public, making hundreds of millions of dollars. 其实,在科赞当上新泽西州州长之前,曾是新泽西州的联邦参议员,再之前,是高盛投资公司的 CEO ,负责高盛的上市,并为其赚取了上亿美元。
This single story reflects a fundamental weakness in our approach to improving health behavior. Nearly everything we tell doctors and everything we tell patients is based on the idea that we behave rationally. 这个简单的故事反映出我们在改善健康行为的方法中的一个基本的弱点。我们告诉医生和病人的一切东西几乎都是基于“人类行为是理性的”观点。
Jon Corzine did not have a knowledge deficit, he had a behavior deficit. It's not that he didn't know better. He knew better. It's that he didn't do better.荣·科赞没有知识缺失,他有的是行为上的缺失。他不是知道的少,他知道的并不少。而他,没能做好。
Instead, I think the mind is a high-resistance pathway. Changing someone's mind with information is hard enough. Changing their behavior with information is harder still. The only way we're going to make substantial improvements in health and health care is to make substantial improvements in the behavior of health and health care.另外,我认为人的思想是个抵御性很强的东西。用信息改变一个人的思想已经够难的了,用信息改变他们的行为更是难上加难。我们能在健康和医疗保健方面做出较大改善的唯一方法,就是尽可能改善人们在健康和医疗保健方面的行为方式。
If you hit my patellar tendon with a reflex hammer, my leg is going to jerk forward, and it's going to jerk forward a lot faster and a lot more predictably than if I had to think about it myself. It's a reflex. We need to look for the equivalent behavioral reflexes and hitch our health care wagon to those.如果你用一个反射锤敲击我的膑腱,我的腿会向前弹起,而且会比我自己想着让它弹起的时候弹得更快,更具可预测性。这是一种反射行为。我们得找到相似的反射行为,并把我们的医疗保健都靠到这些反射行为上来。
A better approach lies in behavioral economics. Behavioral economists recognize that we are irrational. Our decisions are based on emotion, or they're sensitive to framing or to social context. We don't always do what's in our own long-term best interests. But the key contribution to behavioral economics is not in recognizing that we are irrational; it's recognizing that we are irrational in highly predictable ways. 行为经济学中有一个更好的方法。行为经济学家意识到我们其实是非理性的。我们的决定是建立在情绪上的,或是被社会环境或规则框架所影响的。我们不总是会做出有利于我们长远利益的行为。但是,对行为经济学最主要的贡献不是对“人类是非理性的”认识,而是意识到“人类的非理性行为是高度可预测的”。
We see irrationality play out in something called "present bias," where the outcomes in front of us are much more motivating than even more important outcomes far in the future. If I'm on a diet -- and I'm always on a diet --我们可以在一种叫做“即时偏误”的现象中看见非理性的作用,这种现象,是我们正在面对的结果比将来会出现的更重要的结果更能调动我们的积极性。如果我在节食——其实我一直在节食——
and someone offers me a luscious-looking piece of chocolate cake, I know I should not eat that chocolate cake. That chocolate cake will land on that part of my body -- permanently -- where that kind of food naturally settles. But the chocolate cake looks so good and delicious, and it's right in front of me, and the diet can wait 'til tomorrow.这时有人给了我一个看上去很美味的巧克力蛋糕,我知道我不应该吃那个蛋糕。那块巧克力蛋糕会沉积在我身体中——永远——就在这类食物会自然沉积的身体部位上。但是那块巧克力蛋糕看起来如此美味,而且它就在我的眼前,那节食可以明天再说了。
I used to love the comedian Steven Wright. He would have these Zen-like quips. My favorite one was this: "Hard work pays off in the future, but laziness pays off right now."我曾经很喜欢一个喜剧演员,史蒂文·赖特。他经常说些很有禅意的玩笑话。我最喜欢的是这个:“努力了将来会有回报,但是懒惰了现在就会有回报。”
And patients also have present bias. If you have high blood pressure, even if you would desperately like to avoid a stroke, and you know that taking your antihypertensive medications is one of the best ways to reduce that risk, the stroke you avoid is far in the future and taking medications is right now. 患者也有即时偏误。如果你有高血压,即使你极度想避免中风,而且你知道吃降血压药是降低这种风险最有效的方式之一,然而,中风是很久以后可能发生的事,而吃药则是现在要做的。
We also tend to overestimate the value of small probabilities. This actually explains why state lotteries are so popular, even though they return pennies on the dollar. Now, some of you may buy lottery tickets -- it's fun, there's the chance you might strike it rich ... 我们也容易高估小概率事件的价值。这也许能解释为什么国营彩票即使回报极小,却依旧这么受欢迎。在座的一些人可能会买彩票——买彩票挺有意思的,你有可能中大奖、变富有——
It's not that we can't do the math, it's that we can't feel the math.我们并不是不会做数学计算,我们是感受不到这种计算。
And we also pay much too much attention to regret. We all hate the feeling of missing out.而且我们花太多精力在后悔上。我们都痛恨错过机会的感觉。
So, actually, there was this recent lottery, a mega-jackpot lottery, that had a huge payoff, something like over a billion dollars. And everyone in my office is pooling money to buy lottery tickets, and I'm not having any of this. There I am, like, swaggering around the office, "Lotteries are a special tax on people who can't do math."所以,事实上,最近有个彩票,大乐透彩票,回报超高,大概超过 10 亿美元。我办公室里的每个人都在掏钱集资买彩票,我一点都不理解。我在办公室里转悠,嚷嚷着:“彩票是向不会数学计算的人征收的智商税。”
And then it hits me: uh oh. What if they win?然后一个想法击中了我:啊呀,万一他们中奖了呢?
I'm the only one who shows up at work the next day.我就成了第二天唯一来上班的人了。
Now, it's not that I didn't want my colleagues to win. I just didn't want them to win without me. Now, it would have been easier if I had just taken my 20-dollar bill and put it into the office shredder, and the results would have been the same. Even though I knew I shouldn't participate, I handed over my $20 bill, and I never saw it again.不是我不想让我的同事中奖。我只是不想让他们丢下我,自己中奖。如果我当初拿出一张 20 美元钞票直接塞进办公室的碎纸机里,事情本会简单很多,而且结果也会是一样的。即使我知道我不应该参与,我还是递出了 20 美元钞票,之后我再也没见过它。
We've done a bunch of experiments with patients in which we give them these electronic pill bottles so we can tell whether they're taking their medication or not. And we reward them with a lottery. They get prizes. But they only get prizes if they had taken their medication the day before. If not, they get a message that says something like, "You would have won a hundred dollars, but you didn't take your medicine yesterday, so you don't get it."我们和患者做过一些实验。我们给患者们电子药瓶,以便于知道他们是否在吃药。我们用彩票奖励他们。他们能得到奖品。但他们只有在前一天吃药的情况下才能得到奖品。如果没吃,他们会收到一条诸如此类的信息:“你本来能赢 100 美金,但是你昨天没吃药,所以你没法得到这笔钱。”
Well, it turns out, patients hate that. They hate the sense of missing out, and because they can anticipate that feeling of regret and they'd like to avoid it, they're much more likely to take their medications. 事实证明,患者们痛恨那种感觉。他们痛恨错过的感觉,而且因为他们能预判到那种悔恨的感觉,于是想要尽量避开它,所以他们更有可能会吃药了。
Now, this kind of irrationality works out even in men's restrooms. So, for those of you who don't frequent urinals, let me break this down for you.这种非理性甚至在男厕所也能用得上。在座的不常光顾小便池的人,让我给你们解析一下。
There is pee all over the floor.地板上全是尿。
And it turns out that you can solve this problem by etching the image of a fly in the back of the urinal.事实证明,你只要在小便池上蚀刻一个苍蝇的形象,就能解决这个问题。
And it makes perfect sense.这完全说得通。
If I see a fly, I'm gonna get that fly.如果我看见一只苍蝇,我一定要射中那只苍蝇。
That fly is going down.那只苍蝇会被冲入下水道。
Now, this naturally begs the question that if men can aim, why were they peeing on the floor in the first place? In fact, if they were going to pee on the floor, why pee in front of the urinal? You could pee anywhere.这自然地引出了一个问题:如果男人们上厕所时能瞄准,他们一开始为什么要尿到地上?实际上,如果他们本来就打算尿到地上,又为什么要跑到小便池前面去尿?你可以在任何地方尿。
And the same thing works in health care. We had a problem in our hospital in which the physicians were prescribing brand-name drugs when a generic drug was available. Each one of the lines on this graph represents a different drug. And they're listed according to how often they're prescribed as generic medications. 同样的道理也适用于医疗保健。我们医院当时有个这样的问题:当普通药可供选择的时,医生们却一直在开品牌药。这张图上的每条线代表一种不同的药物。这些药根据被当做普通药开的频率被列了出来。
It also works to play into people's notions of loss. We did this with a contest to help people walk more. We wanted everyone to walk at least 7,000 steps, and we measured their step count with the accelerometer on their cell phone.利用人们对损失的概念也有用。我们办了场比赛来帮助人们走更多路。我们想让每个人至少走 7 千步,我们也用他们手机上的计步器以记录他们行走的步数。
Now, an economist would say that those two financial incentives are the same. For every day you walk 7,000 steps, you're $1.40 richer. But a behavioral economist would say that they're different, because we're much more motivated to avoid a $1.40 loss than we are motivated to achieve a $1.40 gain. 一个经济学家可能会说,这两种金钱刺激的结果是一样的。因为每天你走够 7 千步的话,你都能赚 1.4 美金。但是一个行为经济学家会说,它们的结果是不同的,因为我们为避免损失 1.4 美金会比赚取 1.4 美金来得更有动力。
Money can be a motivator. We all know that. But it's far more influential when it's paired with psychology. And money, of course, has its own disadvantages. My favorite example of this involves a daycare program. The greatest sin you can commit in daycare is picking up your kids late. No one is happy. Your kids are crying because you don't love them.钱可以是一个激励因素,我们都知道这一点。但当它与心理学配对使用时更具有影响力。当然,金钱有其自身缺点。我最喜欢的例子,说的是一个日托项目。你能在日托中犯下的最大的罪孽就是接孩子接晚了。没人开心。你的孩子在哭,因为你不爱他们。
The teachers are unhappy because they leave work late. And you feel terribly guilty. This daycare program in Israel decided they wanted to stop this problem, and they did something that many daycare programs in the US do, which is they installed a fine for late pickups.老师不开心,因为他们下班晚了。你也觉得极其内疚。以色列的这个日托项目就想解决这个问题,而且他们做的,是许多美国日托项目也在做的事,就是给晚接孩子的人设置罚款。
you can keep my kids all night!你就能一晚上不用接孩子!
They took a perfectly strong intrinsic motivation not to be late, and they cheapened it. What's worse, when they realized their mistake and they took away the financial incentive, the late pickups still stayed at the high level. They had already poisoned the social contract.家长们卯足了内在动机,准时接孩子,结果日托机构把这个动机因素变得廉价了。更糟的是,当日托机构意识到自己的错误,把迟到罚款的规则撤回时,晚接孩子的情况丝毫没有改观。他们已经毒害了社会契约。
Health care is full of strong intrinsic motivations. We have doctors and patients who already want to do the right thing. Financial incentives can help, but we shouldn't expect money in health care to do all of the heavy lifting. Instead, perhaps the most powerful influencers of health behavior are our social interactions. Social engagement works in health care, and it works in two directions.医疗保健充满了强大的内在动机。医生和患者本身就想做正确的事。金钱刺激也有正面作用。但是我们不能盼着金钱能在医疗保健中承担全部的重任。相反,对健康行为最有效的影响因素可能是我们的社会互动。社会参与在医疗保健中是起作用的,主要体现在两个方面。
First, we fundamentally care what others think of us. And so one of the most powerful ways to change our behavior is to make our activities witnessable to others. We behave differently when we're being observed than when we're not. 第一,我们本能地在意别人对我们的看法。所以改变我们行为最有效的方法之一就是让我们的行为能被别人看见。我们在被观察,和不在被观察时候的行为表现是不同的。
In fact, there was this amazing study that was done in an intensive care unit in a Florida hospital. The handwashing rates were very low, which is dangerous, of course, because it can spread infection. And so some researchers pasted a picture of someone's eyes over the sink. It wasn't a real person, it was just a photograph. In fact, it wasn't even their whole face, it was just their eyes looking at you.事实上,在佛罗里达一家医院的重症监护室里,进行了一项很棒的研究。这里的洗手率非常低,当然,这很危险,因为该行为会传播疾病,导致感染。所以一些研究员在水槽上贴了一张人眼的照片。那不是一个真人,只是一张照片。实际上,那甚至都不是一整张脸,只是一双眼睛看着你。
Handwashing rates more than doubled. It seems we care so much what other people think of us that our behavior improves even if we merely imagine that we're being observed.洗手率翻了不止一倍。我们似乎是如此在意别人对我们的看法,以至于我们的行为会就此改进,即使我们仅仅只是想象我们在被别人观察着。
And not only do we care what others think of us, we fundamentally model our behaviors on what we see other people do. And it all comes back to seat belts. When I was a kid, I used to love the "Batman" TV series with Adam West. Everything that Batman and Robin did was so cool, and, of course, the Batmobile was the coolest thing of all. 而且我们不只是在意别人怎么看我们,我们还会本能地模仿他人行为。这一切又回到安全带上来了。我小的时候,喜欢看亚当·韦斯特演的电视剧《蝙蝠侠》。蝙蝠侠和罗宾做的所有事都特酷,当然了,蝙蝠车是所有事情里最酷的。
And again, it works in health care, too. Doctors use antibiotics more appropriately when they see how other doctors use them. So many activities in health care are hidden, they're unwitnessed, but doctors are social animals, and they perform better when they see what other doctors do. 再次,这在医疗保健中也能起作用。在看见别的医生如何使用抗生素后,医生自己能更加适当地使用抗生素。医疗保健中的许多行动是隐匿的,别人看不见。但医生是社会动物,因此当他们能看见其他医生的做法时,他们自己也能表现得更好。
Now, just to be clear: I am not condemning rationality. I mean, that really would be irrational. But we all know that it's the nonrational parts of our minds where we get courage, creativity, inspiration and everything else that sparks passion. And we know something else, too. 这里我要澄清一点:我不是在指责理性。这才会是真正的不理性。但我们都知道,正是我们思想中那些不理性的部分给予我们勇气、创造力、灵感,以及其他一切能激发激情的东西。我们还知道一些别的。
Thank you.谢谢。
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