My doctoral work focused heavily on trying to understand individual’s utility functions.  That’s a fancy pants way of saying that I was trying to put numbers on what made people more or less happy.  My friend George, who was an undergrad at the time and an outstanding poet, completed one of my surveys.  His responses indicated something pretty wise: he’d rather not be happy *all* the time because his best poetry seemed to flow when he was at least a little blue.  In other words, seriously sad was low on his list, but unrelenting bliss wasn’t at the top.

So I read with interest Jonah Lehrer’s debut piece in the NY Times Magazine speculates on whether depression - from which a non-trivial chunk of the population grapples - offers some sort of selection advantage. The evidence is circumstantial but real: a nagging prevalence, heritability, and at least in its mildest forms some cognitive benefits.

Say what?  Mmm hmm.  Depression - at least in sub-lethal doses - appears to help us increase the ability to focus on tough problems (and crack the more complicated ones), makes us better judges of the accuracy of rumors, improves our ability to remember events, and decreases the chance that we stereotype strangers.  It may be true that - just as my pal George thought - a little bit of blue can be of some practical use.

And apparently the arrow between depression and some cognitive abilities points both ways.  Take Lehrer’s description of a study on the connection between depressed mode and puzzle-solving performance:

This line of research led Andrews to conduct his own experiment, as he sought to better understand the link between negative mood and improved analytical abilities. He gave 115 undergraduates an abstract-reasoning test known as Raven’s Progressive Matrices, which requires subjects to identify a missing segment in a larger pattern. (Performance on the task strongly predicts general intelligence.) The first thing Andrews found was that nondepressed students showed an increase in “depressed affect” after taking the test.  In other words, the mere presence of a challenging problem — even an abstract puzzle — induced a kind of attentive trance, which led to feelings of sadness. It doesn’t matter if we’re working on a mathematical equation or working through a broken heart: the anatomy of focus is inseparable from the anatomy of melancholy.

This hardly means that depression is good, and in its most severe forms, there’s nothing good about it at all.  But it may very well be that a little melancholy is a means to a better end… at least for problems that can be addressed by rumination and focused attention.

Today’s Wall Street Journal reports on an Express Scripts study of GlowCaps, an integrated system for monitoring and improving medication adherence.  Why are we excited about this study? A few important reasons:

• Non-adherence to medications is a major problem. Conservative estimates peg the annual cost of non-adherence at over $100B… and that doesn’t include the pain and suffering that can result from failing to take medications as prescribed.
• There’s no silver bullet solution. Darn!  The causes of non-adherence are many, and no one intervention will solve the problem.
• We’re often looking in the rear-view mirror. It takes months of prescription claims data to get a reliable measure of adherence.  This means PBMs are constantly looking at an issue that took place months ago, and can’t intervene until after a bad habit has formed.
• It’s hard to know what the problem is at the patient level. Claims data aren’t up to the task here, either; they just don’t have the resolution to tell us whether someone is having a problem with side effects, forgetfulness or procrastination on refills.

Approaches like the GlowCap system offer intriguing new ways to address each of these challenges.  GlowCaps enables access to near real-time pill-taking behavior with extremely detailed resolution.  We will, for example, be able to understand which patients do well taking their medications Monday through Friday, but struggle on the weekends.  GlowCaps also offers a great platform for testing applied behavioral science approaches such as precommitment; patients will be able to sign up for phone reminders should they not take their medications on time, as well as adherence reports that can be shared with their physicians.

We’ll keep you posted as we learn more about innovative methods to gain better insights into the problem of therapy adherence… insights that we believe will lead to powerful solutions to drive to better health and value in the pharmacy benefit.

At my local convenience store* the other day, I waited impatiently in line behind an older lady who purchased a gaggle of lottery tickets and a carton of cigarettes. I thought about asking her if she thought the odds were better that she’d hit the jackpot or develop lung cancer, but I decided that I didn’t feel like getting beaten up by one of Betty White’s mahjong buddies.

As the day progressed, I kept coming back to this lady and her profoundly ill-advised purchase. How could she justify wasting money like that? My judgmental tendencies ran wild until I looked at the issue through the prism of hyperbolic discounting.

Sure, the rational move would be to quit smoking and maybe gamble on an investment rather than the Powerball. But let’s face it: Behaving rationally is kind of a pain in the rump. If she walked away from the counter empty-handed, she would only realize the benefits of her decision after the protracted wait for the investment to pay dividends and some serious nicotine withdrawal.

When I put myself in her shoes, her behavior made total sense – even though it really makes no sense at all.

* If there’s a better environment for questionable consumer decision making – especially when it comes to food-like substances – I haven’t found it.

I had the pleasure of speaking with Prof. Brian Wansink the other day.  He’s the food genius who’s done all those funky experiments that remind me of something out of Willy Wonka (e.g., bottomless soup bowls).  Three interlocking insights came to light as we spoke.

First, Wansink’s numero uno big idea is that we eat mindlessly.  That is to say, a surprisingly large degree of our eating behaviors are driven by things of which we are flat out unaware.  (This is exactly the sort of claim that is not ripe for assessment by self reflection, because it’s pretty hard to recall things of we are unaware.)  He’s done the science, and the evidence is in his corner.

Second, Wansink has come to an interesting conclusion about our bellies when it comes to eating:

After conducting hundreds of food studies, I’m increasingly convinced that our stomach has only three settings: 1) We either feel like we’re starving, 2) we feel like we’re stuffed, or 3) we feel like we can eat more. Most of the time we’re in the middle, we’re neither hungry nor full, but if something’s put in front of us, we’ll eat it.

Stop with me for a second or two on this one.  Prof. W is telling us that when it comes to eating, we naturally have three speeds, and none of them is neutral.  Put another way, given the opportunity, we’ll eat to the point of regretting it.

The third idea relates to the first two: little things of which we’re unaware made us fat, and so little things of which we’re unaware can make us slim down as well.  Move the bread and potatoes to the kitchen counter out of reach.  Use smaller plates.  Take that jar of candy off your desk and put it on your bookshelf.  Put treats into a container that takes two hands to open.

There’s a more general design idea at work here: it’s the little foxes that spoil the grapes, but those little foxes take time to do their damage.  And it’s those same little foxes - given time - that can make us healthier and happier.  What are a few little things you can do to make the good behaviors easier and the bad ones just a bit more difficult?

I recently had the chance to speak briefly to our account management team, the hundreds of people who work daily to support the needs of our clients.  They provide excellent consultation, solve problems, and are our heroes in the trenches who help the folks back at HQ understand the evolving, unspoken needs of the market.

Many of the faces were new to me (and only in part due to my spotty memory); gobs of talented people joined Express Scripts from NextRx over the past couple of months.  Clambering onto the stage in my black slacks, blue shirt, sweater vest, and tweed jacket, I introduced myself: “I’m Bob Nease, Chief Scientist at Express Scripts.  Based on what I’m wearing, I know that’s hard to believe; most people mistake me for a professional athlete or a secret agent.”

I was simultaneously pleased and hurt at the reaction: lots of laughter.  (And I know what you’re thinking… when was the last time I heard the phrase “secret agent”?) Over the next couple of days, I got lots of ribbing: “Hey, don’t you play for the Cardinals?” or “Hey, Bob… James Bob!”  Cute.

Which man would you trust more?  (In case you’re confused, I’m the one on the right.)

A recent study suggests that it might be my narrow face rather than the tweed jacket that’s to blame.  In a series of experiments, researchers at the University of St. Andrews found that men with broad faces were less trustworthy in economic exchanges, and that women tended to judge them as both less attractive and less trustworthy.  They summarize their findings (so I don’t have to):

Experiment 1 showed that the ratio of facial (bizygomatic) width to height predicts male reciprocation behavior in trust games such that wider faced males are more likely to exploit trust than are slimmer faced males. In Experiment 2, participants were less likely to trust male counterparts with wide rather than slim faces (independent of their attractiveness). Moreover, in Experiment 3, manipulating face width with computer graphics controlled attributions of trustworthiness, particularly for subordinate female evaluators. These results clearly demonstrate that facial width-to-height ratio is used as a valid cue to trustworthiness.

In other words, nice guys may not always get the girl, but neither do the Neanderthals.  And take that, Daniel Craig!  (But don’t beat me up.)

It’s not surprising that more crimes are committed in the dark.  At first blush (if you could see it), this seems obvious: darkness covers a multitde of sins… mostly by decreasing the chance of getting caught.  But a series of new studies out of Canada suggest that’s not the only thing going on.

In a set of experiments, scientists at the University of Toronto created situations in which cheating was possible (e.g., subjects would solve a series of math puzzles, and then pay themselves for the number of puzzles they got correct without any one checking their work).  Half of the subjects did this task in a brightly lit room; the other half in a more dimly lit room.  The trick was that in both groups there was absolutely no way for anyone to be caught cheating.  Despite the imposed anonymity, a greater fraction of subjects in the darker room cheated (61% vs. 24%), and a greater number of puzzles were falsely claimed to be solved in the darker room (4.2 vs. 0.8).

In a separate study, subjects played the Dictator Game anonymously via computer.  Specifically, subjects were given $6 and told to make a proposed split with an unknown partner online.  Subjects could offer any amount between $0 and $6.  If their partner agreed to the split, the money would be split according to the division proposed by the subject; if not, neither play would receive anything.  Subjects were told they would play the game once, and that that would not meet their partner.  Half the subjects were told to wear tinted sunglasses, while the other half were given identical glasses with no tinting.  Participants wearing sunglasses were far less likely to offer the fair (i.e., 50/50) split, and on average offered $0.90 less than those in the other group.

What’s odd is that in all cases, subjects were assured that their actions would remain anonymous.  Even more strange is the idea that covering one’s one eyes increases self-interested behavior.  This is quite reminiscent of small children who hide by covering their own eyes; because they cannot see, they assume that they cannot be seen.

The bottom line?  The first blush reasoning - that people cheat more in the dark *because* they’re less likely to get caught - may not be the operative mechanism.  Instead, people may be *wired* to cheat more in the dark because that’s generally what works.  The rational part of it may simply the reason behind why the rule of thumb works, not the reason for the behavior itself.

I am a bit of a dweeb, and so I tend to think of words as little encapsulated containers of information: neutral in and of themselves, some better and some worse, but all designed to convey bits.

But this is a whopping mistake.  How you say something matters as much or more as the content.  Political types were the first to understand this, and they still lead the pack / PAC.

Setting aside your own political leanings (and mine), consider these examples in terms of their sheer effectiveness of changing how we react:

• drilling for oil versus exploring for energy
• tax cut versus tax relief
• inheritance tax versus death tax
• troop escalation versus troop surge
• universal health care versus Washington takeover
• power grab versus voter revolt

And the list goes on and on.  Who would argue against No Child Left Behind?  Who could?  (And that’s the point: imagine someone raising their hand and announcing, “Wait just a minute! Hold everything!  I know a couple of kids that should *definitely* be left behind.”)  Healthcare reform that relies on death panels?  Forget about it.  The very words - accurate or not - conjure up an elite group of stiff, uncaring, slightly plugged up bureaucrats whose sole responsibility is to come up with money to finance health care for a bunch of people you don’t know by cutting corners on someone you do, namely your mother.

Those are images that are just flat out hard to undo.  And the more one denies the words that led to the images, the more vivid those images become.

The experts call this sort of thing framing. The power of framing has been proven time and time again.  Frames work because, as the savanty politicolinguistic Frank Luntz notes, it’s not what I say that counts… it’s what you hear.  And what one hears depends a ton on what concepts are activated when we communicate.  These are the frames we use - cues to help us know what to pay attention to and what to ignore, what is good and what is bad.

We now know more about the active ingredients of framing because we have a much better understanding of key psychological principles that shape human behavior.  Loss aversion tells us to emphasize the costs of inaction rather than the benefits of action.  Hyperbolic discounting tells us to make the communication itself beneficial in the moment we receive it (i.e., fun, funny, sweet, enjoyable, racy - where appropriate and to a point).  Social norms tell us to beware appeals to financial incentives alone, as they shift the conversation from Main Street (where we’re all in it together) to Wall Street (where success is measured in dollars and cents).

What cues are you activating when you communicate with others?  With your employees?  When you talk about “managing costs” in health benefits, are you eliciting a hair-trigger grab-the-wallet reaction?  Are you making your message a benefit to receive in the here and now?  Is there a better way for people to hear what you want to say?

The New York Times reports on a study that shows we change our investing behavior when our preferred political party is in power.  Specifically, when the party we favor is in office, we are more likely to invest in risky stocks, move funds from foreign to domestic companies, and trade less frequently.  When our non-preferred party takes office, the opposite behavior is more likely to occur.

The study found that investors with more education and experience were less likely to change their behavior based on political preferences.

The article quotes Dan Ariely, a professor of behavioral economics at Duke University and member of the Center for Cost-Effective Consumerism’s advisory board.

“Though you might think that having money on the line provides a strong-enough incentive to keep political biases from affecting one’s investment decisions, it shouldn’t come as a surprise that it doesn’t,” said Professor Ariely, who is also the author of Predictably Irrational. “In politics as in other arenas of life, our beliefs exert a powerful influence on the decisions we make.”

 For the full article, click here.

In case you were too busy reading actual news to notice, the Oscar nominations came out this week. I’m embarrassed to admit that of the 10 Best Picture nominees, I’ve seen just one — and it was a cartoon.

Maybe I’ll have to check out some of the others. I certainly wouldn’t be the only person watching a movie based purely on Oscar’s seal of approval. Research by Randy Nelson, professor of economics and finance at Colby College, found that a best picture nomination can significantly boost a film’s ticket sales. As Nelson tells it:

[W]e compared box office data for every film nominated for Best Picture, Actor/Actress and Supporting Actor/ Actress from 1978 to 1987 with data for 131 “non-nominated” movies released in the same weeks as the lauded films. … Our results indicate that on average a nomination for Supporting Actor or Actress is worth $147,131; a nomination for Lead Actor or Actress, $476,617; and for Best Picture, $4,799,118.

If you ask me (and why wouldn’t you?), what we have here is a case of social norming — specifically, moviegoers responding to messages from the authority figures at the Academy of Motion Picture Arts and Sciences. After all, who knows movies better than the Hollywood elite?

There might also be a little “keeping up with the Joneses” thrown in. Would you rather say you’ve seen four or five of the Best Picture nominees or just one (or none)? Only a philistine would take pride in such cultural ignorance.

That’s why I’m slapping on some blue face paint and going to Avatar.

Sendhil Mullainathan, a Harvard professor of economics and 2002 receipient of a MacArthur genius grant, explains how applying the behavioral sciences can help us solve “the last mile” of social problems — that is, reaching the subgroup of people who aren’t responding to the available solutions.