The Elephant in the Brain: Hidden Motives in Everyday Life

by Kevin Simler

Maybe not. Consider some of the puzzling data points that Robin discovered. To start with, people in developed countries consume way too much medicine—doctor visits, drugs, diagnostic tests, and so forth—well beyond what’s useful for staying healthy. Large randomized studies, for example, find that people given free healthcare consume a lot more medicine (relative to an unsubsidized control group), yet don’t end up noticeably healthier. Meanwhile, non-medical interventions—such as efforts to alleviate stress or improve diet, exercise, sleep, or air quality—have a much bigger apparent effect on health, and yet patients and policymakers are far less eager to pursue them. Patients are also easily satisfied with the appearance of good medical care, and show shockingly little interest in digging beneath the surface—for example, by getting second opinions or asking for outcome statistics from their doctors or hospitals. (One astonishing study found that only 8 percent of patients about to undergo a dangerous heart surgery were willing to pay $50 to learn the different death rates for that very surgery at nearby hospitals.) Finally, people spend exorbitantly on heroic end-of-life care even though cheap, palliative care is usually just as effective at prolonging life and even better at preserving quality of life. Altogether, these puzzles cast considerable doubt on the simple idea that medicine is strictly about health. To explain these and other puzzles, Robin took an approach un...