TED lecture bilingual speech (word for fine print edition)
: Why it is difficult to make a rational decision?
Speech time: 2019
About the Speaker: David Asch: economist
Speaker Introduction: Why do we make the wrong decision on a health hazard in the case knew of? In this frank and funny speech, behavioral economists and health policy expert David Asch (David Asch) explains why our behavior is often irrational.
Bilingual speech
Translators: Jessie Zhang
Proofreaders: Jiasi Hao
It's April of2007, it was in April 2007,
and Jon Corzine, the Governor of New Jersey, the governor of New Jersey, Ron Corzine (Jon Corzine),
It is in this horrific car accident. passersby a terrible car accident.
He's in the right front passenger seat of this SUV when the SUV he was riding in crashed into the Garden State Parkway,
when it crashes on the Garden State Parkway. He was sitting in the copilot's seat.
He's transported to a New Jersey trauma center he was transferred to a trauma center in New Jersey,
with multiple broken bones and multiple lacerations. body with multiple fractures and torn.
He needs immediate surgery, seven units of blood, he needs immediate surgery, seven pints of blood transfusion,
a mechanical ventilator to help him breathe a ventilator to help him breathe,
and several more operations along the way. That is well and several surgical stroke face.
It's amazing he survived. He can survive really shocking.
But perhaps even more amazing. But it may be more shocking is that
he was not wearing a seat belt. At that time he did not wear a seat belt in the car.
And, in fact, he never wore a seat belt, in fact, he had never before not wearing a seatbelt,
and the New Jersey state troopers who used to drive Governor Corzine around once drove through the New Jersey governor Corzine patrol
used to beg him to wear a seat belt, pipe beg him wearing a seat belt,
but he did not do it. But he never had the Department.
Now, before Corzine was Governor of New Jersey, in fact, in the previous Corzine became governor of New Jersey,
he was the US Senator from New Jersey, was the Senator of New Jersey,
and before that, he was the CEO of Goldman Sachs, until then, was Goldman Sachs CEO,
responsible for taking Goldman Sachs public, responsible for the listing of Goldman Sachs,
making hundreds of millions of dollars. and give it to earn billions of dollars.
No matter politically and Now, no matter what you think of Jon Corzine politically ways to make money from you
or how he made his money, it is how to treat Ron Corzine this man,
nobody would say that he was stupid. Nobody would say that he is a fool.
But there he was, but you see him,
an unrestrained passenger in a car accident, in every American knows that seat belts can save lives when,
at a time when every American knows that seat belts save lives.
He was the scene of an accident in not wearing seat belts people.
This single story reflects a fundamental weakness of this simple story reflects
in our approach to improving health behavior.
A fundamental weakness in our method of improving health behaviors in.
Nearly everything we tell doctors and everything we tell patients we tell the doctor and the patient almost everything
is based on the idea that we behave rationally.
Are based on "human behavior is rational" view.
If you give me information, I will process that information in my head, if you give me information, I will analyze that information, and my behavior will change in the head as a result.
Then my behavior will change.
Do you think Jon Corzine didn't know that seat belts save lives？
Do you think Ron Corzine did not know seat belts can help you?
Do you think he，like，just didn't get the memo？
Do you think he just did not receive a prompt to note it?
（Laughter）
(laughter)
Jon Corzine did not have a knowledge deficit, Wing. Corzine is no lack of knowledge,
he had a behavior deficit.
His absence on some behavior.
It's not that he didn't know better.
He was not to know less, He knew better.
And he knows a lot.
It's that he didn't do better.
And he did not do a good job.
Instead，I think the mind is a high-resistance pathway.
In addition, I believe that the human mind is something very strong to resist.
Changing someone's mind with information is hard enough. Change one's mind with information already difficult enough,
Changing their behavior with information with information to change their behavior
It is harder still. even more difficult.
The only way we're going to make substantial improvements we can in terms of health and health care
The only way in health and health care make a big improvement, is to make substantial improvements in the behavior of health and health care.
It is to improve the way people behavior in health and health care as much as possible.
If you hit my patellar tendon with a reflex hammer, if you tap my patella tendon with a reflex hammer, my leg is going to jerk forward, my legs will bounce forward,
and it's going to jerk forward a lot faster and a lot more predictably than I thought and let it bounce when
than if I had to think about it myself.
Playing faster and more predictable.
It's a reflex.
This is a reflex behavior.
We need to look for the equivalent behavioral reflexes we have to find a similar reflection behavior, and hitch our health care wagon to those.
And our health care are up against these acts of reflection.
Turns out, though, but in fact, that most conventional approaches to human motivation
Most conventional motivate people to move
are based on the idea of education.
But it is built on the "education" of the concept.
We assume that if people do not behave as they should, we assume that if people did not make them proper behavior
it's because they didn't know any better.
Because they lack knowledge.
"If only people knew that smoking was dangerous，they wouldn't smoke."
"If people know that smoking is dangerous, they will not smoke."
Or，we think about economics.
Or, we will think from an economic point of view.
The assumption there is that we're all constantly calculating we assume that they will continue to calculate
the costs and benefits of every one of our actions each of our behavior inherent costs and benefits, and optimizing that to make the perfectly right, rational decision.
And in order to maximize revenue, we will make absolutely correct and rational decisions.
If that were true, then all we need to do if this is true, all we need
is to find the perfect payment system for doctors just to find a perfect payment system to the doctor, or the perfect co-payments and deductibles for patients, or patients with perfectly calculated to give portions bear the costs and deductibles, and everything would work out.
Then everything will naturally be solved.
A better approach lies in behavioral economics.
Behavioral economics, there is a better way.
Behavioral economists recognize that we are irrational.
Behavioral economists realized that we actually irrational.
Our decisions are based on emotion, our decisions are based on emotions, or they're sensitive to framing or to social context.
Or be influenced by the social environment or regulatory framework.
We don't always do what's in our own long-term best interests.
We do not always help us to make long-term interests.
But the key contribution to behavioral economics, however, the most important contribution to behavioral economics
is not in recognizing that we are irrational; not the understanding of "human reason is well", it's recognizing that we are irrational in highly predictable ways.
But we realized that the "rational human behavior is highly predictable."
In fact, it's the predictability of our psychological foibles fact, it is our psychological defects of those little predictability
that allows us to design strategies to overcome them.
So that we can devise strategies to overcome them.
Forewarned is forearmed.
Forewarned is just like pre-armed.
In fact, behavioral economists often use the fact, behavioral economists often use precise
precisely the same behavioral reflexes that get us into trouble that made us fall into troublesome behaviors reflection,
and turn them around to help us, in turn, allow them to help us, rather than to hurt us.
Rather than hurt us.
We see irrationality play out in something called"present bias，"
We can be called "real-time bias" phenomenon seen in irrational action, where the outcomes in front of us are much more motivating this phenomenon is the result we are facing
than even more important outcomes far in the future.
More important than the result of stroke to occur more to mobilize our enthusiasm.
If I'm on a diet--and I'm always on a diet--
If I'm on a diet - in fact, I've been on a diet -
（Laughter）
(laughter)
and someone offers me a luscious-looking piece of chocolate cake, and someone gave me a look very delicious chocolate cake, I know I should not eat that chocolate cake.
I know I should not eat that cake.
That chocolate cake will land on that part of my body--permanently--
Piece of chocolate cake will be deposited in my body - forever -
where that kind of food naturally settles.
Just kind of food on the body parts will naturally deposition.
But the chocolate cake looks so good and delicious, but that piece of chocolate cake looks so delicious, and it's right in front of me,
And it's in my eyes, and the diet can wait'til tomorrow.
Dieting can say that tomorrow.
Iused to love the comedian Steven Wright.
I was very fond of a comedian Steven Wright.
He would have these Zen-like quips.
He often said something very Zen joke.
My favorite one was this: My favorite is this:
"Hard work pays off in the future，
"Efforts to have a stroke to return, but laziness pays off right now."
But now there will be a lazy return. "
And patients also have present bias.
Patients also have immediate bias.
Ifyou have high blood pressure, if you have high blood pressure, even if you would desperately like to avoid a stroke, even if you're desperate to avoid a stroke, and you know that taking your antihypertensive medications and you know what to eat blood pressure medicine
is one of the best ways to reduce that risk, this risk is to reduce one of the most effective ways,
the stroke you avoid is far in the future and taking medications is right now.
However, stroke is the thing may happen much later, and medicine is to do now.
Almost half of the patients who are prescribed high blood pressure pills opened almost half of patients with antihypertensive drugs
stop taking them within a year.
Within a year to stop the medication.
Think of how many lives we could save if we think about this problem alone solve
if we could solve just that one problem.
How many lives can be saved.
We also tend to overestimate the value of small probabilities.
We also easy to overestimate the value of small probability event.
This actually explains why state lotteries are so popular, and this may explain why the state-run lottery even a very small return, even though they return pennies on the dollar.
But still so popular.
Now，some of you may buy lottery tickets--
Some people here might buy lottery tickets -
it's fun，there's the chance you might strike it rich...
Lottery very interesting, you may hit the jackpot, become rich -
But let's face it: But let's sober now:
this would be a horrible way to invest your retirement savings.
This may be a very bad way to spend your pension.
1 once saw a bumper sticker - I am not making this up - that said, I had seen a bumper sticker - I am not making this one - that says,
"State lotteries are a special tax on people who can't do math."
"The state-run lottery is not a mathematical calculation of the tax levied IQ."
（Laughter）
（笑声）It's not that we can't do the math，
It's not that we can not do the math, we are not do not do math, it's that we can not feel the math.
We feel this is calculated.
And we also pay much too much attention to regret.
And we spend too much energy on regrets.
We all hate the feeling of missing out.
We all hate the feeling of missed opportunities.
So, actually, there was this recent lottery, so, in fact, recently there is a lottery, a mega-jackpot lottery, Lotto lottery, that had a huge payoff, something like over a billion dollars.
Returns high, probably over $ 1 billion.
And everyone in my office is pooling money to buy lottery tickets, in my office everyone is raising money to buy lottery tickets, and I'm not having any of this.
I do not understand.
There I am, like, swaggering around the office, I was wandering around in the office, clamored:
"Lotteries are a special tax on people who can't do math."
"Lottery is not a mathematical calculation of the tax levied IQ."
（Laughter）
(Laughter) And then it hits me: Then an idea struck me:
uh oh.
Oh, What if you win?
If they won the lottery it? (Laughter]
（笑声）I'm the only one who shows up at work the next day.
I became the only person to come to work the next day of the.
（Laughter）
（笑声）Now，it's not that I didn't want my colleagues to win.
I do not want to let my colleagues hit the jackpot.
I just didn't want them to win without me.
I just do not want them to leave me, myself winning.
Now, it would have been easier if I had just taken my 20-dollar bill if I had to come up with a $ 20 bill directly into the shredder in the office, and put it into the office shredder, this matter will be made easier , and the results would have been the same.
And the result will be the same.
Even though I knew I should not participate, even though I know I should not be involved, Ihanded over my $ 20 bill, I handed out a $ 20 bill, and I never saw it again.
Then I never saw it. (Laughter]
(Laughter) We've done a bunch of experiments with patients and the patients we did some experiments.
in which we give them these electronic pill bottles我们给患者们电子药瓶，so we can tell whether they're taking their medication or not.
In order to know whether they are taking medicine.
And we reward them with a lottery.
We reward them with a lottery.
They get prizes.
They can get prizes.
But they lower case only get prizes but they are only the previous day to take medicine
if they had taken their medication the day before.
Get prizes.
If not, they get a message that says something like, if eaten, they will receive a message like:
"You would have won a hundred dollars，
"You could win $ 100,
but you didn't take your medicine yesterday，so you don't get it."
But you do not take medicine yesterday, so you can not get the money. "
Well，it turns out，patients hate that.
It turns out that the patient had hated that feeling.
They hate the sense of missing out, they hate the feeling of missed, and because they can anticipate that feeling of regret but also because they can predict the kind of feeling remorse, and they'd like to avoid it, so you want to avoid as much as possible open it, they're much more likely to take their medications.
So they are more likely to take medicine.
Harnessing that sense of hating regret works.
Control of the kind of hate regret feeling is useful.
And it leads to the more general point, it leads to a more general point of view, which is: once you recognize how people are irrational, that is: once you realize that people are rational Well, you're in a much better position to help them.
You will be in a better position to help them.
Now，this kind of irrationality works out even in men's restrooms.
This rational even that can use the men's room.
So, for those of you who do not frequent urinals, urinal here do not often patronize people, let me break this down for you.
Let me give you parse it. (Laughter)
（笑声）There is pee all over the floor.
The urine all over the floor.
（Laughter）
(Laughter) And it turns out that you can solve this problem it turns out, you just etch an image on a urinal flies, by etching the image of a fly in the back of the urinal.
We can solve this problem.
（Laughter]（Applause）
(Laughter) (Applause)
And it makes perfect sense.
It all makes sense.
（Laughter]
(Laughter) IfI see a fly, if I see a fly, I'm gonna get that fly.
I have to hit the bird flies. (Laughter]
（笑声）That fly is going down.
The fly may blow drains.
Now, this naturally begs the question that if men can aim, which naturally begs the question: If men can aim at the toilet, why were they peeing on the floor in the first place?
Why should they start the urine to the ground?
In fact, if they were going to pee on the floor, in fact, if they were already going to the urine to the ground, why pee in front of the urinal?
Why have to go to the front of the urinal to the urine?
You could pee anywhere.
You can pee in any place.
（Laughter）
（笑声）And the same thing works in health care.
The same thing applies to health care.
We had a problem in our hospital we have a hospital at that time the question:
in which the physicians were prescribing brand-name drugs when generic drug alternative, when a generic drug was available.
Doctors has been in the brand-name drug.
Each one of the lines on this graph represents a different drug.
Each line on this graph represents a different drug.
And they're listed according to how often they're prescribed as generic medications.
According to these drugs is treated as ordinary prescribe frequencies are listed.
Until, someone installed a little piece of software until there is someone in the electronic health record table
in the electronic health record install a small software, that defaulted the prescriptions to generic medications to prescription generic drugs is set to open by default, instead of the brand-name drugs.
Rather than brand-name drugs.
Now, it does not take a statistician now, no statistical analyst
to see that this problem was solved overnight, can see it, the problem will be solved overnight, and it has stayed solved ever since.
And then, after no such problems.
In fact, in the two and a half years since this program started, in fact, in this project two and a half, our hospital has saved 32 million dollars line.
Our hospitals have saved $ 32 million.
Let me say that again：32 million dollars.
Let me say a force: $ 32 million.
And all we did was make it easier we have done, just the doctor who has been wanted to do
for the doctors to do what they fundamentally wanted to do all along.
Easy to do it.
It also works to play into people's notions ofloss.
People use the concept of loss is also useful.
We did this with a contest to help people walk more.
We do the game to help more people walk the road.
We wanted everyone to walk at least 7,000 steps, we want everyone to walk at least 7,000 steps, and we measured their step count pedometer we also use them on your phone
with the accelerometer on their cell phone.
To record the number of steps they walk.
Group A, the control group, just got told whether they had walked A group, the control group variable, only they were told
7，000 steps or not.
It is enough to walk 7,000 steps.
Group B got a financial incentive.
Group B, there are financial incentives.
We gave them $1.40 for every day they walked 7，000 steps.
Every day if they walked 7,000 steps, we will reward them 1.4 dollars.
Group C got the same financial incentive, group C, the same financial incentives, but it was framed as a loss rather than a gain: but this stimulation is packaged instead return loss:
$ 1.40 a day is 42 dollars a month, 1.4 dollars a day or 42 dollars a month, so we gave these participants 42 dollars at the beginning of each month so the first day of each month we gave the participants 42 dollars,
in a virtual account that they could see, you could see on their virtual account, and we took away $ 1.40 for every day they did not walk 7,000 steps.
Then if they had not gone 7,000 steps a day enough, we removed 1.4 dollars from the account.
Now, an economist would say that those two financial incentives an economist might say, both financial incentives results
are the same.
it's the same.
For every day you walk 7，000 steps，you're $1.40 richer.
Because every day you walk 7,000 steps enough, you can earn 1.4 dollars.
But a behavioral economist would say that they're different, but a behavioral economists would say, their results are different, because we're much more motivated to avoid a $ 1.40 loss because we have to avoid losses than to earn US $ 1.4 take 1.4 dollars
than we are motivated to achieve a $1.40 gain.
Come more motivated.
And that's exactly what happened.
The results also true.
Those in the group that received $ 1.40 for every day they walked 7,000 steps a day because those who walk 7,000 steps and received a $ 1.4
were no more likely to meet their goal than the control group.
No better than the control variable group (no monetary incentives) to better achieve our goals.
The financial incentive didn't work.
Financial incentives did not work.
But those who had a loss-framed incentive and those who suffered losses stimulus
met their goal 50 percent more of the time.
There are 50% likely to complete a higher goal.
It does not make economic sense, but it makes psychological sense, it does not make sense in economics, but the psychology is plausible, because losses loom larger than gains.
Because of the greater losses than gains from the stimulus.
And now we're using loss-framed incentives to help patients walk more, and now we have this loss stimulation to help patients take the road more, lose weight lose weight, and take their medications.
And take medicine.
Money can be a motivator.
Money may be a motivating factor, We all know that.
We all know that.
But it's far more influential when it's paired with psychology.
But when the more influential when it is paired with psychology.
And money，of course，has its own disadvantages.
Of course, money has its drawbacks.
My favorite example of this involves a daycare program.
My favorite example of that is a day care project.
The greatest sin you can commit in daycare is picking up your kids late.
The biggest sin you can commit is to pick up their kids in day care pick late.
No one is happy.
Nobody happy.
Omit some text
Instead, perhaps the most powerful influencers of health behavior contrary to the health behaviors of the most effective factors
are our social interactions.
It may be our social interaction.
Social engagement works in health care, community involvement in health care is active, and it works in two directions.
Mainly reflected in two aspects.
First，we fundamentally care what others think of us.
First, we instinctively care about what others think of us.
One And so one of the most powerful ways to change our behavior to change our behavior so the most effective way
is to make our activities witnessable to others.
It is to let our actions be seen by others.
We behave differently when we're being observed we observed, and not observed when the behavior than when we're not.
It is different.
I've been to some restaurants that don't have sinks in the bathrooms.
I've been to a few restaurants, they do not sink the toilet,
Instead, when you step out, the sink is outside but when you come out, sink on the outside, in the main part of the restaurant, the main location of the hotel, where everyone can see whether you wash your hands or not.
This time everyone can see you do not wash your hands wash.
Now, I do not know for sure, I'm not sure, but I am convinced that handwashing is much greater but I can guarantee that in those particular circumstances
in those particular settings.
Wash your hands people changed much.
We are always on our best behavior when we're being observed.
When we observed, always show the best behavior.
In fact, there was this amazing study in fact, in a hospital in Florida
that was done in an intensive care unit in a Florida hospital.
A great study of intensive care unit, were.
The handwashing rates were very low, which is dangerous, of course, there's often hand-washing rates low well, of course, this is very dangerous, because it can spread infection.
Because this behavior spread disease, leading to infection.
And so some researchers pasted a picture of someone's eyes over the sink.
So some researchers in the sink posted a photo of the human eye.
It wasn't a real person，it was just a photograph.
It was not a real person, just a picture.
In fact，it wasn't even their whole face，it was just their eyes looking at you.
In fact, it is not even a whole face, just a pair of eyes looking at you.
（Laughter]
（笑声）Handwashing rates more than doubled.
Wash your hands more than double the rate doubled.
It seems we care so much what other people think of us we seem to be so concerned with what others think of us, that our behavior improves our behavior so that this will improve, even if we merely imagine that we're being observed.
Even if we imagine that we are just people watching.
And not only do we care what others think of us, and we do not just care about how others see us, we fundamentally model our behaviors on what we see other people do.
We also instinctively imitate the behavior of others.
And it all comes back to seat belts.
It all comes back onto the seat belt.
When I was a kid，I used to love the"Batman"TV series with Adam West.
When I was, like watching Adam West played in the TV series "pieces of Batman."
Everything that Batman and Robin did was so cool all things, bat Batman and Robin do have special cool, and, of course, the Batmobile was the coolest thing of all.
Of course, everything bat bat car is the coolest.
Now, that show aired from 1966 to 1968, the TV series broadcast from 1966 to 1968, and at that time, seat belts were optional accessories in cars.
At that time, the car seat belt or optional accessories.
But the producers of that show did something really important.
But that drama producer did something very important to do well.
When Batman and Robin got in the Batmobile, Batman and Robin when bat bat bat bike riding car, the camera would focus on their laps, the camera will focus their legs, and you would see Batman and Robin put on their seat belts.
Then you will see a Bat Batman and Robin tied to their belts.
Now，if Batman and Robin put on their seat belts，
If the bat Batman and Robin tied a seat belt, you can bet that I was going to wear my seat belt, too.
You can bet I will fasten my seat belt.
I bet that show saved thousands of lives.
I bet that the drama has saved thousands of lives.
And again，it works in health care，too.
Again, this can also play a role in health care.
Doctors use antibiotics more appropriately when they see how other doctors use them.
After seeing how other doctors to use antibiotics, the doctors themselves can be more appropriate use of antibiotics.
So many activities in health care are hidden, they're unwitnessed, health care in many actions are hidden, others can not see.
but doctors are social animals, but doctors are social animals,
and they perform better when they see what other doctors do.
So when they can see other physician practices, they themselves can perform better.
So social influence works in health care.
So social impact in health care have a positive effect, So does tying it to notions of regret or to loss aversion.
It with a sense of regret and loss aversion linked also helpful.
We would never think of using these tools if we thought that everyone was rational if we think that every time people are rational, all the time.
That we would never think of using these tools.
Now，just to be clear:I am not condemning rationality.
Here I want to clarify one thing: I'm not accusing reason.
I mean，that really would be irrational.
This is true not only rational.
But we all know that it's the nonrational parts of our minds but we all know what we thought irrational part of those
where we get courage, creativity, inspiration gives us the courage, creativity, inspiration, and everything else that sparks passion.
And all other things can inspire passion.
And we know something else，too.
We also know something else.
We know that we can be much more effective at improving health behavior that we know if we can cooperate nature in part irrational and, if we work with the irrational parts of our nature rather than ignore, or reverse the come with them,
instead of ignoring them or fighting against them.
We can more effectively improve our health behaviors.
When it comes to health care, when it comes to health care, understanding our irrationality is just another tool in our toolbox.
We understand the irrational is only a tool in the toolbox.
And harnessing that irrationality--
The control of this rational -
that may be the most rational move of all.
All behavior is perhaps the most rational.
Thank you.