A problem I have tried to highlight is that healthism (medical care, “healthy lifestyles”, prevention, etc) does not always lead to better average outcomes.

A study I just ran across offered people a choice between enhanced probability of survival, a pretty major health outcome, and raw healthism. The people chose healthism.

Cure me even if it kills me: preferences for invasive cancer treatment.

PURPOSE: When making medical decisions, people often care not only about what happens but also about whether the outcome was a result of actions voluntarily taken or a result of inaction. This study assessed the proportion of people choosing nonoptimal treatments (treatments which reduced survival chances) when presented with hypothetical cancer scenarios which varied by outcome cause.

METHODS: A randomized survey experiment tested preferences for curing an existent cancer with 2 possible treatments (medication or surgery) and 2 effects of treatment (beneficial or harmful). Participants were 112 prospective jurors in the Philadelphia County Courthouse and 218 visitors to the Detroit-Wayne County Metropolitan Airport.

RESULTS: When treatment was beneficial, 27% of participants rejected medication, whereas only 10% rejected surgery with identical outcomes ( 2 = 5.87, P < 0.02). When treatment was harmful, participants offered surgery were significantly more inclined to take action (65% v. 38%, chi(2) = 11.40, P = 0.001), even though doing so reduced overall survival chances.

CONCLUSIONS: Faced with hypothetical cancer diagnoses, many people say they would pursue treatment even if doing so would increase their chance of death. This tendency toward active treatment is notably stronger when the treatment offered is surgery instead of medication. Our study suggests that few people can imagine standing by and doing nothing after being diagnosed with cancer, and it should serve to remind clinicians that, for many patients, the best treatment alternative may not only depend on the medical outcomes they can expect to experience but also on whether those outcomes are achieved actively or passively.

Now, there are lots of reasons why this might make sense. People want to go down swinging. They want to feel like they did something.

It may be that on a deep level we are not programmed to avoid death so much as we are programmed to fight for life. This makes perfect sense as an evolutionary design. Attack-threats-to-life is an easier problem to solve than maximize-life-expectancy and in the natural environment the two are likely to yield roughly the same answer.

However, in the modern environment this is not always the case. Sometimes taking a wait-and-see approach is the optimal survival strategy, even if it doesn’t feel right.

The policy question within all of this is whether or not the government should subsidize, fully in some cases, people making choices which are likely to lead to worse health outcomes. I am of course not suggesting that people, not be allowed to pursue worse health outcomes if that’s what they want.

However, should the state be picking up the tab?

About these ads