Your Medical Mind_ How to Decide What Is Right for You - Jerome Groopman [6]
As physicians, each of us has cared for patients for over three decades, and countless times we’ve heard people like Susan Powell recount how a family member, friend, or acquaintance decided to take a treatment and suffered its side effects—like the lady at church. Other times we’ve heard how someone they knew declined treatment and lived well into old age—like her father. We’ve also seen patients who came in requesting a particular medication or brand because of a testimonial from a friend with a similar problem.
Such stories can be reassuring or upsetting, but either way they profoundly sculpt preferences. Each vivid case becomes a mirror reflecting a potential future. Availability bias is perhaps the most powerful and prevalent force shaping how patients initially assess their options.
Of course, it was chance that Susan saw that woman in church. But if she hadn’t, she would likely have gone on the Internet and found a similar tale from someone who felt fine and then suffered muscle pain, the most common side effect of statins, or someone else who developed liver toxicity and gastrointestinal upset, which are less common but also risks of taking statins. To be sure, seeing a person in front of you has a greater impact than hearing about side effects secondhand. But even secondhand stories affect the way people think.
We have also observed in our clinical practice that the stories a patient encounters, like that of the woman in church, may amplify preexisting mind-sets and biases. Susan is a doubter. “This was how I was raised,” she told us. “This is how my husband is. And this is how we taught our children to deal with their health.”
Other people may decline a statin medication because of the widely prevalent idea that natural is best. According to this concept, nature is wise, and the body does best on its own. Voltaire, who shared this view, asserted that “the art of medicine consists in amusing the patient while nature cures the disease.”
Many people who subscribe to this idea believe they should rely on exercise and specific foods, like oat bran or red wine, or “natural” supplements to treat high cholesterol. They view medications as unnatural chemicals that pose unwarranted hazards. This mind-set can be termed a “naturalism” orientation or, in the language of cognitive science, a “naturalism bias.” It is the firm belief that there exist smarter and safer natural ways to prevent and treat illness without resorting to synthetic solutions.
Gretchen Chapman, a professor of psychology at Rutgers University who has extensively studied how patients make decisions, illustrates such a bias with the following test: A person is asked whether he or she prefers a medication derived from a natural source like a plant or a chemically identical medication synthesized in a laboratory. People with a naturalism bias choose the compound from the plant even though it is indistinguishable from the one made in the lab.
Susan has never had any serious medical problems and feels good. “Every day, I count my blessings,” she told us. She believes that she has much to lose by abandoning her skeptical approach and taking a medication. Her sense of well-being and independence; her pleasure in caring for her family and her patients; her joy in celebrating with her community at church—all of this, she fears, could be erased by a small white oval pill.
Susan is healthy, but even people who are not well will often hesitate to try a new therapy. The cliché “Better the devil you know than the one you don’t” advises staying with the status quo as preferable to taking an action that could make life even worse. Psychologists call this “loss aversion.” Research in cognitive science has shown that people experience loss more profoundly than gain. And one’s aversion to loss is even more powerful when the potential gain is delayed or uncertain. In