JAMA Forum: Choosing wisely is hard

I have a new post up on the JAMA Forum. What’s going on here?

In one experiment, family practitioners were presented with 1 of 2 scenarios involving a man with chronic hip pain. In one scenario, respondents were asked to select between referring the man to surgery only or to do so in combination with initiating ibuprofen. In the other scenario, a third option was added: surgical referral and initiation of piroxicam. When this third option was added, more respondents elected surgical referral only, relative to the 2-option scenario (72% elected surgical referral vs 53% elected surgical referral plus ibuprofen). Somehow, offering the option of another drug decreased the appeal of prescribing any drug.

Also, here’s a bit of bonus material that I cut for length:

Consumers more readily buy items—including big ticket items like cars—when they’re labeled “on sale,” even if the price hasn’t changed. After the Texas electricity market was deregulated in 2002, the incumbent provider retained a dominant market share, even though customers could have saved nearly $150 per year by switching. Other work shows that the order and manner in which options are presented to consumers affects their choices.

Thorough searching and comparing isn’t easy. One study estimated that, on average, consumers would have to save $200 for the effort of searching for and switching to a new auto insurance policy to be worth it. Another posits that consumers are rational in their lack of thorough consideration of durable goods’ energy efficiency (like that of cars and large home appliances), because doing takes considerable time and effort.

Of course, it would not be rational (I assert) for you not to invest the time and effort to read the post.


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