Superfreakonomics_ global cooling, patri - Steven D. Levitt [93]
As word got around, other hospitals began copying the screen-saver solution. And why not? It was cheap, simple, and effective.
A happy ending, right?
Yes, but…think about it for a moment. Why did it take so much effort to persuade doctors to do what they have known to do since the age of Semmelweis? Why was it so hard to change their behavior when the price of compliance (a simple hand-wash) is so low and the potential cost of failure (the loss of a human life) so high?
Once again, as with pollution, the answer has to do with externalities.
When a doctor fails to wash his hands, his own life isn’t the one that is primarily endangered. It is the next patient he treats, the one with the open wound or the compromised immune system. The dangerous bacteria that patient receives are a negative externality of the doctor’s actions—just as pollution is a negative externality of anyone who drives a car, jacks up the air conditioner, or sends coal exhaust up a smokestack. The polluter has insufficient incentive to not pollute, and the doctor has insufficient incentive to wash his hands.
This is what makes the science of behavior change so difficult.
So instead of collectively wringing our filthy hands about behavior that is so hard to change, what if we can come up with engineering or design or incentive solutions that supersede the need for such change?
That’s what Intellectual Ventures has in mind for global warming, and that is what public-health officials have finally embraced to cut down on hospital-acquired infections. Among the best solutions: using disposable blood-pressure cuffs on incoming patients; infusing hospital equipment with silver ion particles to create an antimicrobial shield; and forbidding doctors to wear neckties because, as the U.K. Department of Health has noted, they “are rarely laundered,” “perform no beneficial function in patient care,” and “have been shown to be colonized by pathogens.”
That’s why Craig Feied has worn bow ties for years. He has also helped develop a virtual-reality interface that allows a gowned and gloved-up surgeon to scroll through X-rays on a computer without actually touching it—because computer keyboards and mice tend to collect pathogens at least as effectively as a doctor’s necktie. And the next time you find yourself in a hospital room, don’t pick up the TV remote control until you’ve disinfected the daylights out of it.
Perhaps it’s not so surprising that it’s hard to change people’s behavior when someone else stands to reap most of the benefit. But surely we are capable of behavior change when our own welfare is at stake, yes?
Sadly, no. If we were, every diet would always work (and there would be no need for diets in the first place). If we were, most smokers would be ex-smokers. If we were, no one who ever took a sex-ed class would be party to an unwanted pregnancy. But knowing and doing are two different things, especially when pleasure is involved.
Consider the high rate of HIV and AIDS in Africa. For years, public-health officials from around the world have been fighting this problem. They have preached all sorts of behavior change—using condoms, limiting the number of sexual partners, and so on. Recently, however, a French researcher named Bertran Auvert ran a medical trial in South Africa and came upon findings so encouraging that the trial was halted so the new preventive measure could be applied at once.
What was this magical treatment?
Circumcision. For reasons Auvert and other scientists do not fully understand, circumcision was found to reduce the risk of HIV transmission by as much as 60 percent in heterosexual men. Subsequent studies in Kenya and Uganda corroborated Auvert’s results.
All over Africa, foreskins began to fall. “People are used to policies that target behaviors,” said one South African