What nudge theory got wrong

Tim Harford

The Financial Times

Originally posted 

Here is an excerpt:

Chater and Loewenstein argue that behavioural scientists naturally fall into the habit of seeing problems in the same way. Why don’t people have enough retirement savings? Because they are impatient and find it hard to save rather than spend. Why are so many greenhouse gases being emitted? Because it’s complex and tedious to switch to a green electricity tariff. If your problem is basically that fallible individuals are making bad choices, behavioural science is an excellent solution.

If, however, the real problem is not individual but systemic, then nudges are at best limited, and at worst, a harmful diversion. Historians such as Finis Dunaway now argue that the Crying Indian campaign was a deliberate attempt by corporate interests to change the subject. Is behavioural public policy, accidentally or deliberately, a similar distraction?

A look at climate change policy suggests it might be. Behavioural scientists themselves are clear enough that nudging is no real substitute for a carbon price — Thaler and Sunstein say as much in Nudge. Politicians, by contrast, have preferred to bypass the carbon price and move straight to the pain-free nudging.

Nudge enthusiast David Cameron, in a speech given shortly before he became prime minister, declared that “the best way to get someone to cut their electricity bill” was to cleverly reformat the bill itself. This is politics as the art of avoiding difficult decisions. No behavioural scientist would suggest that it was close to sufficient. Yet they must be careful not to become enablers of the One Weird Trick approach to making policy.

-------

Behavioural science has a laudable focus on rigorous evidence, yet even this can backfire. It is much easier to produce a quick randomised trial of bill reformatting than it is to evaluate anything systemic. These small quick wins are only worth having if they lead us towards, rather than away from, more difficult victories.

Another problem is that empirically tested, behaviourally rigorous bad policy can be bad policy nonetheless. For example, it has become fashionable to argue that people should be placed on an organ donor registry by default, because this dramatically expands the number of people registered as donors. But, as Thaler and Sunstein themselves keep having to explain, this is a bad idea. Most organ donation happens only after consultation with a grieving family — and default-bloated donor registries do not help families work out what their loved one might have wanted.

The info is here.

Technological seduction and self-radicalization

Alfano, M., Carter, J., & Cheong, M. (2018). 

Journal of the American Philosophical Association, 

4(3), 298-322. doi:10.1017/apa.2018.27

Abstract

Many scholars agree that the Internet plays a pivotal role in self-radicalization, which can lead to behaviors ranging from lone-wolf terrorism to participation in white nationalist rallies to mundane bigotry and voting for extremist candidates. However, the mechanisms by which the Internet facilitates self-radicalization are disputed; some fault the individuals who end up self-radicalized, while others lay the blame on the technology itself. In this paper, we explore the role played by technological design decisions in online self-radicalization in its myriad guises, encompassing extreme as well as more mundane forms. We begin by characterizing the phenomenon of technological seduction. Next, we distinguish between top-down seduction and bottom-up seduction. We then situate both forms of technological seduction within the theoretical model of dynamical systems theory. We conclude by articulating strategies for combating online self-radicalization.

A pdf is here.

Shouldn’t We Make It Easy to Use Behavioral Science for Good?

Manasee Desai
www.behavioralscientist.org
Originally posted September 4, 2018

The evidence showing that applied behavioral science is a powerful tool for creating social good is growing rapidly. As a result, it’s become much more common for the world’s problem solvers to apply a behavioral lens to their work. Yet this approach can still feel distant to the people trying urgently to improve lives on a daily basis—those working for governments, nonprofits, and other organizations that directly tackle some of the most challenging and pervasive problems facing us today.

All too often, effective strategies for change are either locked behind paywalls or buried in inaccessible, jargon-laden articles. And because of the sheer volume of behavioral solutions being tested now, even people working in the fields that compose the behavioral sciences—like me, for instance—cannot possibly stay on top of every new intervention or application happening across countless fields and countries. This means missed opportunities to apply and scale effective interventions and to do more good in the world.

As a field, figuring out how to effectively report and communicate what we’ve learned from our research and interventions is our own “last mile” problem.

While there is no silver bullet for the problems the world faces, the behavioral science community should (and can) come together to make our battle-tested solutions available to problem solvers, right at their fingertips. Expanding the adoption of behavioral design for social good requires freeing solutions from dense journals and cost-prohibitive paywalls. It also requires distilling complex designs into simpler steps—uniting a community that is passionate about social impact and making the world a better place with applied behavioral science.

That is the aim of the Behavioral Evidence Hub (B-Hub), a curated, open-source digital collection of behavioral interventions proven to impact real-world problems.

The info is here.

The Psychology of Clinical Decision Making: Implications for Medication Use

Jerry Avorn
February 22, 2018
N Engl J Med 2018; 378:689-691

Here is an excerpt:

The key problem is medicine’s ongoing assumption that clinicians and patients are, in general, rational decision makers. In reality, we are all influenced by seemingly irrational preferences in making choices about reward, risk, time, and trade-offs that are quite different from what would be predicted by bloodless, if precise, quantitative calculations. Although we physicians sometimes resist the syllogism, if all humans are prone to irrational decision making, and all clinicians are human, then these insights must have important implications for patient care and health policy. There have been some isolated innovative applications of that understanding in medicine, but despite a growing number of publications about the psychology of decision making, most medical care — at the bedside and the systems level — is still based on a “rational actor” understanding of how we make decisions.

The choices we make about prescription drugs provide one example of how much further medicine could go in taking advantage of a more nuanced understanding of decision making under conditions of uncertainty — a description that could define the profession itself. We persist in assuming that clinicians can obtain comprehensive information about the comparative worth (clinical as well as economic) of alternative drug choices for a given condition, assimilate and evaluate all the findings, and synthesize them to make the best drug choices for our patients. Leaving aside the access problem — the necessary comparative effectiveness research often doesn’t exist — actual drug-utilization data make it clear that real-world prescribing choices are in fact based heavily on various “irrational” biases, many of which have been described by behavioral economists and other decision theorists.

The article is here.

Failing better

Erik Angner
BPP Blog, the companion blog to the new journal Behavioural Public Policy
Originally posted June 2, 2017

Cass R. Sunstein’s ‘Nudges That Fail’ explores why some nudges work, why some fail, and what should be done in the face of failure. It’s a useful contribution in part because it reminds us that nudging – roughly speaking, the effort to improve people’s welfare by helping them make better choices without interfering with their liberty or autonomy – is harder than it might seem. When people differ in beliefs, values, and preferences, or when they differ in their responses to behavioral interventions, for example, it may be difficult to design a nudge that benefits at least some without violating anyone’s liberty or autonomy. But the paper is a useful contribution also because it suggests concrete, positive steps that may be taken to help us get better simultaneously at enhancing welfare and at respecting liberty and autonomy.

(cut)

Moreover, even if a nudge is on the net welfare enhancing and doesn’t violate any other values, it does not follow that it should be implemented. As economists are fond of telling you, everything has an opportunity cost, and so do nudges. If whatever resources would be used in the implementation of the nudge could be put to better use elsewhere, we would have reason not to implement it. If we did anyway, we would be guilty of the Econ 101 fallacy of ignoring opportunity costs, which would be embarrassing.

The blog post is here.

Nudging, informed consent and bullshit

William Simkulet
Journal of Medical Ethics Published Online 
First: 18 November 2017. doi: 10.1136/medethics-2017-104480

Abstract

Some philosophers have argued that during the process of obtaining informed consent, physicians should try to nudge their patients towards consenting to the option the physician believes best, where a nudge is any influence that is expected to predictably alter a person’s behaviour without (substantively) restricting her options. Some proponents of nudging even argue that it is a necessary and unavoidable part of securing informed consent. Here I argue that nudging is incompatible with obtaining informed consent. I assume informed consent requires that a physician tells her patient the truth about her options and argue that nudging is incompatible with truth-telling. Instead, nudging satisfies Harry Frankfurt’s account of bullshit.

The article is here.

Don’t Nudge Me: The Limits of Behavioral Economics in Medicine

Aaron E. Carroll
The New York Times - The Upshot
Originally posted November 6, 2017

Here is an excerpt:

But those excited about the potential of behavioral economics should keep in mind the results of a recent study. It pulled out all the stops in trying to get patients who had a heart attack to be more compliant in taking their medication. (Patients’ adherence at such a time is surprisingly low, even though it makes a big difference in outcomes, so this is a major problem.)

Researchers randomly assigned more than 1,500 people to one of two groups. All had recently had heart attacks. One group received the usual care. The other received special electronic pill bottles that monitored patients’ use of medication. Those patients who took their drugs were entered into a lottery in which they had a 20 percent chance to receive $5 and a 1 percent chance to win $50 every day for a year.

That’s not all. The lottery group members could also sign up to have a friend or family member automatically be notified if they didn’t take their pills so that they could receive social support. They were given access to special social work resources. There was even a staff engagement adviser whose specific duty was providing close monitoring and feedback, and who would remind patients about the importance of adherence.

This was a kitchen-sink approach. It involved direct financial incentives, social support nudges, health care system resources and significant clinical management. It failed.

The article is here.

Conviction, persuasion and manipulation: the ethical dimension of epistemic vigilance

Johannes Mahr
Cognition and Culture Institute Blog
Originally posted 10 March 2017

In today’s political climate moral outrage about (alleged) propaganda and manipulation of public opinion dominate our discourse. Charges of manipulative information provision have arguably become the most widely used tool to discredit one’s political opponent. Of course, one reason for why such charges have become so prominent is that the way we consume information through online media has made us more vulnerable than ever to such manipulation. Take a recent story published by The Guardian, which describes the strategy of information dissemination allegedly used by the British ‘Leave Campaign’:

“The strategy involved harvesting data from people’s Facebook and other social media profiles and then using machine learning to ‘spread’ through their networks. Wigmore admitted the technology and the level of information it gathered from people was ‘creepy’. He said the campaign used this information, combined with artificial intelligence, to decide who to target with highly individualised advertisements and had built a database of more than a million people.”

This might not just strike you as “creepy” but as simply unethical just as it did one commentator cited in the article who called these tactics “extremely disturbing and quite sinister”. Here, I want to investigate where this intuition comes from.

The blog post is here.

Affective nudging

Eric Schliesser
Digressions and Impressions blog
Originally published September 30, 2016

Here is an excerpt:

Nudging is paternalist. But by making exit easy and avoidance cheap nudges are thought to avoid the worst moral and political problems of paternalism and (other) manipulative practices. (What counts as a significant change of economic incentives is, of course, very contestable, but we leave that aside here.) Nudges may, in fact, sometimes enhance autonomy and freedom, but the way Sunstein & Thaler define 'nudge' one may nudge also for immoral ends. Social engineering does not question the ends.

The modern administrative state is, however, not just a rule-following Weberian bureaucracy where the interaction between state and citizen is governed by the exchange of forms, information, and money. Many civil servants, including ones with very distinct expertise (physicians, psychologists, lawyers, engineers, social service workers, therapists, teachers, correction officers, etc.) enter quite intimately into the lives of lots of citizens. Increasingly (within the context of new public management), government professionals and hired consultants are given broad autonomy to meet certain targets (quotas, budget or volume numbers, etc.) within constrained parameters. (So, for example, a physician is not just a care provider, but also somebody who can control costs.) Bureaucratic management and the political class are agnostic about how the desired outcomes are met, as long as it is legal, efficient and does not generate bad media or adverse political push-back.

The blog post is here.

Could a device tell your brain to make healthy choices?

by Yasmin Anwar
Futurity
Originally posted June 13, 2016

New research suggests it’s possible to detect when our brain is making a decision and nudge it to make the healthier choice.

In recording moment-to-moment deliberations by macaque monkeys over which option is likely to yield the most fruit juice, scientists have captured the dynamics of decision-making down to millisecond changes in neurons in the brain’s orbitofrontal cortex.

The article is here.

Doctors often overestimate promise of newly approved drugs

By Dennis Thompson
HealthDay News
Originally posted April 12, 2016

Here is an excerpt:

The U.S. Congress in 2012 gave FDA the power to designate a drug as a "breakthrough therapy" if preliminary clinical evidence suggests an advantage over existing medications.

But a survey of nearly 700 doctors revealed that many tended to misinterpret "breakthrough." Doctors often believed the drugs were supported by stronger evidence than the law requires to achieve that designation, said lead author Dr. Aaron Kesselheim. He is a faculty member at Brigham and Women's Hospital in Boston.

"When people hear 'breakthrough,' it gives them an inappropriately elevated sense of what the drug might do," Kesselheim said. "It may give physicians false reassurance about the outcomes they might expect to receive when they prescribe it."

The article is here.

American attitudes toward nudges

Janice Y. Jung and Barbara A. Mellers
Judgment and Decision Making
Vol. 11, No. 1, January 2016, pp. 62-74

To successfully select and implement nudges, policy makers need a psychological understanding of who opposes nudges, how they are perceived, and when alternative methods (e.g., forced choice) might work better. Using two representative samples, we examined four factors that influence U.S. attitudes toward nudges – types of nudges, individual dispositions, nudge perceptions, and nudge frames. Most nudges were supported, although opt-out defaults for organ donations were opposed in both samples. “System 1” nudges (e.g., defaults and sequential orderings) were viewed less favorably than “System 2” nudges (e.g., educational opportunities or reminders). System 1 nudges were perceived as more autonomy threatening, whereas System 2 nudges were viewed as more effective for better decision making and more necessary for changing behavior. People with greater empathetic concern tended to support both types of nudges and viewed them as the “right” kind of goals to have. Individualists opposed both types of nudges, and conservatives tended to oppose both types. Reactant people and those with a strong desire for control opposed System 1 nudges. To see whether framing could influence attitudes, we varied the description of the nudge in terms of the target (Personal vs. Societal) and the reference point for the nudge (Costs vs. Benefits). Empathetic people were more supportive when framing highlighted societal costs or benefits, and reactant people were more opposed to nudges when frames highlighted the personal costs of rejection.

The article is here.

Episode 24: The Nudge in Ethics, Psychotherapy, and Public Policy

Nudge theory has gained popularity in behavioral science, mainly in the field of behavioral economics.  The theory broadly indicates that indirect suggestions or contextual changes can influence choices or compliance with healthy behaviors or decisions.  Nudge theory contrasts its approach with direct suggestions, instructions, and education.  In psychotherapy, we nudge patients frequently.  Sometimes we do it consciously, other times unconsciously.  Because of this potentially powerful influence over our clients, we must remain vigilant about our nudges in the form of soft paternalism or projecting our values onto our patients.  Psychologists must be mindful of the power imbalance in the psychotherapy relationship and our duty to respect client autonomy. 

John’s guest is Dr. Jennifer Blumenthal-Barby, Associate Professor of Medicine and Medical Ethics, Center for Medical Ethics and Health Policy, Baylor College of Medicine, located in Texas.

Click here for CE Credit for psychologists and other professionals

At the end of the podcast, the participants will be able to:

1. Describe what “Nudge Theory” is;
2. Explain how Nudge Theory applies to ethics in the psychotherapy relationship;
3. Name two ways that psychologists can use nudge theory to promote healthy behaviors.

References

Blumenthal-Barby J.S., Burroughs H. (2012). Seeking better health care outcomes: the ethics of using the "nudge".   American Journal of Bioethics. Volume 12(2): 1-10.

Blumenthal-Barby, J.S. McCullough, L.B., Kreiger, H. and Coverdale, J.C. (2013). Methods of Influencing the Decisions of Psychiatric Patients: An Ethical Analysis. Harvard Review of Psychiatry, Volume 21 (5), 275-279.

DeAngelis, T. Coaxing Better Behavior. (2014). The Monitor on Psychology. Volume 45(11): 62.

Knapp, S. and Gavazzi, J. (2014). Is it Ever Ethical to Lie to a Patient? The Pennsylvania Psychologist.

Barkan, R. Ayal, S. and Ariely, D. (2010). Ethical dissonance, justifications, and moral behavior. Current Opinion in Psychology, Volume 6, December 2015, 157-161.

Sunstein, C. R. Fifty Shades of Manipulation. (2015). Journal of Behavioral Marketing.

Sunstein, C. R. The Ethics of Nudging. (2014). Social Science Research Network.

Seeking better health care outcomes: the ethics of using the "nudge".

Blumenthal-Barby JS, Burroughs H.
Am J Bioeth. 2012;12(2):1-10.
doi: 10.1080/15265161.2011.634481.

Abstract

Policymakers, employers, insurance companies, researchers, and health care providers have developed an increasing interest in using principles from behavioral economics and psychology to persuade people to change their health-related behaviors, lifestyles, and habits. In this article, we examine how principles from behavioral economics and psychology are being used to nudge people (the public, patients, or health care providers) toward particular decisions or behaviors related to health or health care, and we identify the ethically relevant dimensions that should be considered for the utilization of each principle.

The article is here.

The Power of Nudges, for Good and Bad

By Richard Thaler
The New York Times - The Upshot
Originally published October 31, 2015

Here are two excerpts:

Whenever I’m asked to autograph a copy of “Nudge,” the book I wrote with Cass Sunstein, the Harvard law professor, I sign it, “Nudge for good.” Unfortunately, that is meant as a plea, not an expectation.

Three principles should guide the use of nudges:

■ All nudging should be transparent and never misleading.

■ It should be as easy as possible to opt out of the nudge, preferably with as little as one mouse click.

■ There should be good reason to believe that the behavior being encouraged will improve the welfare of those being nudged.

(cut)

Some argue that phishing — or evil nudging — is more dangerous in government than in the private sector. The argument is that government is a monopoly with coercive power, while we have more choice in the private sector over which newspapers we read and which airlines we fly.

I think this distinction is overstated. In a democracy, if a government creates bad policies, it can be voted out of office. Competition in the private sector, however, can easily work to encourage phishing rather than stifle it.

One example is the mortgage industry in the early 2000s. Borrowers were encouraged to take out loans that they could not repay when real estate prices fell. Competition did not eliminate this practice, because it was hard for anyone to make money selling the advice “Don’t take that loan.”

The entire article is here.

Doctors, Patients, and Nudging in the Clinical Context-Four Views on Nudging and Informed Consent

Ploug T and Holm S
Am J Bioeth. 2015 Oct;15(10):28-38.

Abstract

In an analysis of recent work on nudging we distinguish three positions on the relationship between nudging founded in libertarian paternalism and the protection of personal autonomy through informed consent. We argue that all three positions fail to provide adequate protection of personal autonomy in the clinical context. Acknowledging that nudging may be beneficial, we suggest a fourth position according to which nudging and informed consent are valuable in different domains of interaction.

The entire article is here.

Fifty Shades of Manipulation

Cass R. Sunstein
Journal of Behavioral Marketing, Forthcoming
February 18, 2015

Abstract:    

A statement or action can be said to be manipulative if it does not sufficiently engage or appeal to people’s capacity for reflective and deliberative choice. One problem with manipulation, thus understood, is that it fails to respect people’s autonomy and is an affront to their dignity. Another problem is that if they are products of manipulation, people’s choices might fail to promote their own welfare, and might instead promote the welfare of the manipulator. To that extent, the central objection to manipulation is rooted in a version of Mill’s Harm Principle: People know what is in their best interests and should have a (manipulation-free) opportunity to make that decision. On welfarist grounds, the norm against manipulation can be seen as a kind of heuristic, one that generally works well, but that can also lead to serious errors, at least when the manipulator is both informed and genuinely interested in the welfare of the chooser.

For the legal system, a pervasive puzzle is why manipulation is rarely policed. The simplest answer is that manipulation has so many shades, and in a social order that values free markets and is committed to freedom of expression, it is exceptionally difficult to regulate manipulation as such. But as the manipulator’s motives become more self-interested or venal, and as efforts to bypass people’s deliberative capacities becomes more successful, the ethical objections to manipulation become very forceful, and the argument for a legal response is fortified. The analysis of manipulation bears on emerging first amendment issues raised by compelled speech, especially in the context of graphic health warnings. Importantly, it can also help orient the regulation of financial products, where manipulation of consumer choices is an evident but rarely explicit concern.

The entire article is here.

The Ethics of Nudging

By Cass Sunstein
Harvard Law School

Abstract:
 
This essay defends the following propositions. (1) It is pointless to object to choice architecture or nudging as such. Choice architecture cannot be avoided. Nature itself nudges; so does the weather; so do spontaneous orders and invisible hands. The private sector inevitably nudges, as does the government. It is reasonable to object to particular nudges, but not to nudging in general. (2) In this context, ethical abstractions (for example, about autonomy, dignity, and manipulation) can create serious confusion. To make progress, those abstractions must be brought into contact with concrete practices. Nudging and choice architecture take diverse forms, and the force of an ethical objection depends on the specific form. (3) If welfare is our guide, much nudging is actually required on ethical grounds. (4) If autonomy is our guide, much nudging is also required on ethical grounds. (5) Choice architecture should not, and need not, compromise either dignity or self-government, though imaginable forms could do both. (6) Some nudges are objectionable because the choice architect has illicit ends. When the ends are legitimate, and when nudges are fully transparent and subject to public scrutiny, a convincing ethical objection is less likely to be available. (7) There is, however, room for ethical objections in the case of well-motivated but manipulative interventions, certainly if people have not consented to them; such nudges can undermine autonomy and dignity. It follows that both the concept and the practice of manipulation deserve careful attention. The concept of manipulation has a core and a periphery; some interventions fit within the core, others within the periphery, and others outside of both.

The entire article is here.

Coaxing better behavior

Behavioral science is playing a pivotal role in research and policymaking that seeks to gently steer us toward better decisions.

By Tori DeAngelis
The Monitor on Psychology
December 2014, Vol 45, No. 11
Print version: page 62

Here is an excerpt:

But social psychology has probably never held as much potential to change global outcomes as it does now. Governments and other organizations are applying "nudge principles" — psychologists' findings about the human propensities that influence our decisions and actions — to collect unpaid taxes, reduce child mortality, and help people choose healthier foods and make better environmental choices. In one line of study, for example, researchers found that people recycled much more when their trash bin lids featured cut-out shapes of the objects to be recycled, be they circles for cans and bottles or slits for paper.

The entire article is here.

It’s All for Your Own Good

By Jeremy Waldron
The New York Book Review
Originally published on October 9, 2014

Here is an excerpt:

Nudging is an attractive strategy. People are faced with choices all the time, from products to pensions, from vacations to voting, from requests for charity to ordering meals in a restaurant, and many of these choices have to be made quickly or life would be overwhelming. For most cases the sensible thing is not to agonize but to use a rule of thumb—a heuristic is the technical term—to make the decision quickly. “If it ain’t broke don’t fix it,” “Choose a round number,” “Always order the special,” and “Vote the party line” are all heuristics. But the ones people use are good for some decisions and not others, and they have evolved over a series of past situations that may or may not resemble the important choices people currently face.

The entire article is here.