by Dan Ariely
Scientific findings do not always portray us in a favorable light. Although we sometimes discover how wonderful we are or how difficult it is for computers to reason the way we do so naturally (see “Mind vs. Machine” by Brian Christian), we occasionally uncover things about ourselves that are not particularly flattering. As just one example, we overestimate risks that evoke emotion or are highly salient, and we underestimate risks that fail to give us the chills. As Jason Daley writes in “What You Don’t Know Can Kill You,” “a risk-perception apparatus permanently tuned for avoiding mountain lions makes it unlikely that we will ever run screaming from a plate of mac ’n’ cheese.” And with obesity at an all-time high, this presents a pretty substantial problem. But we can use even the bleakest findings to invent new ways to correct for our mistakes and improve our lives. Through such contributions from science, we are able to learn about our flaws and find solutions that mitigate their consequences.
The Downside
The downside is that for each scientific finding, the conclusions we arrive at may limit our options, both professionally and personally. With each science-based recommendation for policies or procedures, we essentially become a more paternalistic society. And most of us are (understandably) uncomfortable with paternalism and its implication of a condescending, one-way relationship in which our lives can be dictated by others. We value freedom for freedom’s sake, we value the flexibility to make different decisions depending on our particular circumstances, and we value the ability to choose for ourselves. For all of these reasons, the prospect of setting strict top-down limits is undesirable and complicated.
Nelson Mandela once said, “There is no such thing as part freedom.” But was he correct in this sentiment? Or do we value freedom too highly, such that we are harming ourselves as we embark on a relentless pursuit for the freedom to @$#%! up? Alternatively, can we establish a system in which our freedoms are intact but limited in a way that protects us from ourselves? Maybe Robert Frost had a more suitable concept of freedom when he noted, “If society fits you comfortably enough, you call it freedom.” Should we relinquish our romanticized vision of freedom and replace it with a more realistic version that accounts for our humanness? Using our scientific toolkit, we can make society comfortable enough to feel free, even if we give some concessions in arenas where it is in our best interest to accept a bit of guidance. For example, we can take advantage of smart feedback systems like those described by Thomas Goetz in “The Feedback Loop” to get people to drive more slowly or take their cholesterol medication. This way, we can simultaneously preserve their freedom to speed, but we can also install “speed meters” that effectively discourage it.
Given the complex costs (limiting freedom) and benefits (better outcomes) that such systems would entail, there is no simple or single answer to how and when we should be paternalistic. Instead, we should consider each case independently and weigh its specific costs and benefits before making decisions that could limit personal freedoms. At the same time, as in all scientific ventures, we should look for principles that can guide our decisions about when to intervene and when to let people make their own mistakes. I would like to propose two such principles: interdependence and agency.
The Principle of Interdependence
John Stuart Mill’s influential definition of freedom, which seems to hold up even today, can inform our decisions about when paternalism may be more or less necessary. As Mill said, “The only freedom which deserves the name is that of pursuing our own good in our own way, so long as we do not attempt to deprive others of theirs, or impede their efforts to obtain it. Each is the proper guardian of his own health, whether bodily, or mental or spiritual.” In theory, as long as we’re not harming others, we can do as we choose. We are free to get blindingly drunk in the comfort of our own homes as long as we harm only ourselves. But as soon as we try to drink and drive, our actions become a serious crime —regardless of the consequences.
With this principle in mind, we can more easily predict some situations in which a paternalistic stance would be highly advisable. For example, one arena where we readily accept a high degree of regulation is driving: we abide by restrictions on age, location, speed, and parking. People are required to wear seat belts, are severely punished if they drink and drive, and risk a hefty ticket when they attempt to use their cell phones. And still, few people advocate for “freedom from seat belts” (although I’m sure there are some libertarians open to this discussion).
In contrast, people are generally opposed to the regulation of private events. If someone chooses to be reckless on his own—juggling chain saws, for example—we consider it up to that person to decide whether it’s a good idea or not. I suspect that very few people would want to add an age limit or license requirements to the use of power tools.
However, while the distinction between activities that affect only ourselves and those that affect others appears fairly easy to determine, in many cases it is not—and in a socially connected world, this distinction gets even muddier. For example, is the person who chooses to binge-drink at home, never intending to get behind the wheel, really hurting only himself? He’s not endangering drivers, but what if he has a wife and kids? What if he needs a liver transplant and is chosen to receive one over someone who has not put himself at risk for liver damage? I’m not advocating for greater regulation of alcohol sales, but I am suggesting that what can seem like one person’s problem may actually leak outside that individual’s sphere. As society moves forward, we are beginning to realize how interdependent we are; think about the financial crisis of 2008, when subprime mortgages in the United States brought the world economy to its knees. In areas where our interests and our personal lives overlap and are increasingly intertwined, we may need to adopt more paternalistic methods in order to ensure our safety and well-being.
The Principle of Agency
A second principle that we can use to guide our paternalistic recommendations comes from our view of agency, or the ability of individuals to make good decisions for themselves and for others. The most salient example is that of parenting. We don’t exactly trust children to be the best judges of what to eat or whether they need to go to school. If my son were left to his own devices, he would probably build elaborate forts and eat crème brûlée all day. Both David Dobbs’s “Beautiful Brains” and David Eagleman’s “The Brain on Trial” confront the issue of agency head on; these articles point to the complexities of human development and diversity and how they relate to the decisions we make. And as Eagleman puts forth, “Perhaps not everyone is equally ‘free’ to make socially appropriate choices.” We are not all equipped with the same genes, environmental surroundings, or life experiences (which is, of course, a good thing), and it is unfair to treat everyone in exactly the same way as if we were indistinguishable beings.
But the question of agency is not limited to children and criminals. In fact, much of the research in decision making and behavioral economics highlights how we overestimate the amount of control we have over our decisions and underestimate the forces that influence us. To the extent that we all suffer from these biases and a sense of magnified agency, there must be more cases where a higher degree of paternalism is in order.
From this perspective, let’s consider conflicts of interest. While we may realize that such conflicts exist and that they influence others, we fail dramatically in perceiving both the extent of their effects and our own susceptibility to them. In one of my favorite studies on conflicts of interest, Ann Harvey, Ulrich Kirk, George Denfield, and Read Montague asked participants to rate how much they liked sixty paintings, ranging from medieval to modern, from the collections of two different art galleries. Half of the participants were told that their payment ($30, $100, or $300) for taking part in the study was sponsored by Gallery A; the other half were told that the sponsor was Gallery B. Each painting had one of the two galleries’ logos on it—half of the paintings had Gallery A’s logo and half had B’s. As you
may have predicted, participants tended to prefer the paintings from their sponsoring gallery, which could be explained by a subconscious feeling of the need to reciprocate. However, the story does not end there.
Brain scans of participants showed that the presence of their sponsoring gallery’s logo caused increased activity in the parts of the brain related to pleasure (particularly the ventromedial prefrontal cortex, a part of the brain that is responsible for higher-order thinking, including associations and meaning). What’s more, this activity increased substantially—along with participants’ admiration for their sponsoring gallery’s paintings—with each rise in payment. It may seem surprising that a financial favor could influence one’s enjoyment of art, especially considering that the favor (payment for participation) was completely unrelated to the paintings. But as with many other types of favors, it was all too easy to create a feeling of gratitude and the desire to reciprocate. And, importantly, none of the participants thought their payment had any influence over their decisions. When asked whether they preferred their sponsoring gallery because of the payment, they scoffed at the mere suggestion.
This lack of appreciation for the power of conflicts of interest is reflected in the real world. A few years ago I gave a lecture on conflicts of interest to about two thousand members of the American Medical Association. I asked how many of the physicians in the audience felt that their judgments were affected by conflicts of interest with their hospital, drug manufacturers, insurance companies, medical device manufacturers, or pharmaceutical sales representatives—and not a single person raised a hand. But when I asked whether they believed that the judgments of other doctors in the room were influenced by conflicts of interest, nearly everyone raised a hand. And again, when I asked whether they believed that the judgments of the majority of the MDs in the room were influenced by conflicts of interest, nearly everyone raised a hand.
Once we establish that conflicts of interest create a bias and that we do not appreciate how this bias influences us, we can ask whether we should try to eliminate conflicts of interest altogether. For example, we have laws prohibiting bribery in myriad forms, but what about lobbying? And should we allow companies to finance presidential elections through contributions? Should we allow doctors to receive gifts and benefits from pharmaceutical and device companies? Should we allow bankers to be paid exorbitant amounts when their investments happen to do well and load them first onto the lifeboat when they fail? If we recognize that people are unlikely to see the effects of conflicts of interest on themselves and are therefore unlikely to self-regulate, we should be willing to consider a more paternalistic approach.
Now, for the sake of “freedom of choice,” we might decide that we want to allow physicians to consult for medical companies, because without them companies might not improve their products. We might insist on paying bankers large bonuses even when their investments fail, because otherwise “the smartest and brightest would no longer be attracted to this noble profession.” But I suspect that if we truly understood the incredible force that conflicts of interests have in shaping our behaviors, we would not endorse such practices, and we would even attempt to eradicate them.
Where Do We Go from Here?
So here’s the issue: if we want to get people to take healthier and better paths in our complex and tempting modern world, we will have to prescribe new instructions, practices, and regulations—and those in turn will inevitably limit our freedoms. Given that most of us are apprehensive about surrendering autonomy, and for good reason, we should not take such decisions lightly. After all, allowing people to make their own decisions is important to our sense of self and independence, and a society without such basic freedoms is unlikely to be successful or happy.
At the same time, we need to acknowledge that our fallibilities and our level of societal interdependence are much more extensive than we give them credit for. With such limited agency and such expansive interdependence, we may want to open the door to science-based paternalism.
How should we determine when and under which conditions we should introduce paternalism or phase it out? In my view, we should apply a careful cost-benefit analysis to each case. First, we should consider whether (or to what extent) a particular case is one in which an individual’s actions are likely to damage others. Next, we should determine whether in this case people are likely to naturally make decisions that are in their best long-term interest. If the answers to these two questions are “yes” and “no,” respectively, we should empirically examine a range of potential interventions —starting with small-scale studies—to measure the potential costs and benefits of various solutions. To retain personal freedoms, we should begin by experimenting with more hands-off approaches that provide better information (such as posting calorie information in restaurants and measuring whether this has any effect on the consumption of unhealthy foods). And only if we can document empirically that these interventions fail or fall short of expectations should we move to more invasive and paternalistic interventions. For example, in the case of posting calorie information, the evidence across multiple studies (for example, see the 2012 study by J. A. Schwartz, J. Riis, B. D. Elbel, and D. Ariely) is quite clear that merely providing calorie information does not encourage healthier eating. This means that it is time to try more aggressive approaches, such as taxation or smaller default portion sizes.
In the end, the level of paternalism we want in our society is not going to be fully determined by science because there is no way to fully capture the costs involved in restricting the freedom of people and societies. Perhaps one day we will figure out how to measure such costs, but until then we should use science as an input to help us understand which areas of life we should regulate to a higher degree and to come up with interventions that balance effectiveness with minimum impact on personal freedoms. It is not going to be easy, but as our living environments become more and more complex, with more and more temptations surrounding us, it is going to be even more important to figure out where we can succeed on our own, when we need a little helping hand, and where we need the strength of a whole arm.
For me, this is one of the main goals for science in the years to come—to figure out the human condition and design our environment to reduce our tendency for error and maximize our potential.
Irrationally Yours,
DAN ARIELY
P.S. My deepest thanks go to Aline Grüneisen, in particular for help with this book.
References
Harvey, Ann, et al., “Monetary Favors and Their Influence on Neural Responses and Revealed Preference,” Journal of Neuroscience (2010).
Schwartz, J. A., et al., “Inviting Consumers to Downsize Fast-Food Portions Significantly Reduces Calorie Consumption,” Health Affairs 31, no. 2 (2012): 399–407.
PART ONE: Bacteria/Microorganisms
BRENDAN BUHLER
The Teeming Metropolis of You
FROM California Magazine
YOU ARE MOSTLY not you. That is to say, 90 percent of the cells residing in your body are not human cells; they are microbes. Viewed from the perspective of most of its inhabitants, your body is not so much the temple and vessel of the human soul as it is a complex ambulatory feeding mechanism for a methane reactor in your small intestine.
This is the kind of information microbiologists like to share at dinner parties, and you should too, especially if you can punctuate it with a belch.
It’s not that our bodies aren’t enormously interesting in themselves, only that they are not the whole story—not nearly. Each of us is a colonized country, a host of multitudes, a reservoir of biodiversity. Indeed, the species of bacteria living on your left hand are different from those living on your right.
At the dawn of the twenty-first century, navel gazing is on the frontiers of biology and medicine, as proven by the Belly Button Biodiversity Project at North Carolina State University. They take swabs, sequence DNA, and post photographs of the resulting cultures. (Request a kit on
line!)
And our biota—all the living creatures in and on us—is not a set of merely passive passengers. The bacteria in our gut aid our digestion and, as we are increasingly discovering, help defend us from pathogens. There are a couple of ways of thinking about how they protect us, says Russell Vance, a University of California, Berkeley, professor studying the interactions of bacteria and the immune system. The first protection is by simply existing.
Think of your body as a big city apartment building. Our normal biota comprises its tenants, and they’re solid folk. They keep up the maintenance, take out the trash, and pay their rent—that is to say, they promote healthy tissue growth, comprise the majority of the dry mass in our feces, and, by fermenting carbohydrates, provide us with roughly a quarter of our calories. Just by maintaining building occupancy, they keep bad elements from moving in as squatters, beating up the superintendent, ripping out the copper pipes, and turning the whole place into a crack den—that is, they compete for nutrients, occupy the mucous lining, and sites in the intestine where pathogens might attach and attack.
Another way our tenants protect the place is by actively policing the hallways—a healthy biota makes the pH of our guts inhospitable and even toxic to many pathogens.
What’s more, the bacteria in our guts act as a scrimmage team for our immune system. Over our lifetimes, our bacteria and our immune systems compete with each other, but for reasons scientists are still figuring out, never too aggressively. They take the field against each other, but they don’t play tackle football.
To some extent, this makes sense; after all, if harmless bacteria were playing for keeps, they wouldn’t be harmless—they would be attacking our intestinal cells and colonizing the rest of our body. Similarly, if our immune systems were fighting at full strength, we would be sick all the time, since most of the experience of being ill—fevers, aches, coughing, runny noses, and so on—is the result of our body trying to make itself inhospitable to microorganisms.