Rory Sutherland: Want Fewer People to go to A&E? Change the Name | Health | WIRED

um very first simple point to make which is just worth making before I say anything else which is that psychology is technology although we think of them as completely separate things all technological advance comes from the understanding of the property of something whether it be silicone or stainless steel or nitrogen or whatever comes from understanding a property as you get better at understanding these properties technology gets better and the properties of human behavior and the human brain should not be excluded from that quest that's all I'm saying I'm just a co-founder of overly change which is part of Ogilvy which as I describe it aims to solve the problems that ad agencies have never been asked to solve historically the ad agency only really got asked it had an interesting mixture of talents within the building but it was only asked to solve problems which involved spending money on mass media and my exam the problem of that actually is it actually it never really got to the deepest understanding of human psychology because mass media tends to be a fairly blunt instrument intervention my view is that once digital technology came along and it was possible to actually intervene in far more subtle kind of microsurgery ways our understanding of the subtleties of human behavior had to increase commensurately and I what I tend to do I always have a huge complaint I've got nothing against economists okay I got nothing against the forces of naive rationality except for the fact that they always get two problems first so if you think about it it's much easier to be fired for being irrational that it is to be fired for being unimaginative for example there's a huge rationality bias that pervades everything we do and the problem I always have is that when you when you go to engineers you will always get engineering problems engineering solutions when you go to mathematicians economists you will always get solutions that involve incentives direct financial incentive don't mind that those kind of incentives are fine sometimes they work the thing I do grudge is that those people are effectively handed the problem on a plate they redefine the problem in terms of their own imagined solution and no one else gets a look-in sometimes it would help if a greater variety of a solution approaches were just brought in to bear in parallel I have a particularly and at the moment you probably know about the the problem with the overuse of A&E in the UK my advertising solution which may be mad is to go to the BBC and ITV in the major media and say can you please not call it a and E it used to be called accident an emergency and that gave you a clue as to the circumstances under which you should use that part of the hospital it might even be good if you took the advertising idea further to actually have blood and screaming coming from A&E to discourage people from going there except in the most desperate circumstances but actually what you call things affects how people behave accident an emergency that's a place I really shouldn't go to unless it's pretty desperate hey Andy it's like your best mate isn't it okay it's even an entertaining American TV channel just to add further confusion to the whole thing um brilliant advertising intervention a beautiful beautiful idea at Harvard the phrase designated driver was created by a team of behavioral scientists and they encouraged soap operas sitcoms and so forth to inject the phrase into their plot lines because if you create a name for something we automatically assume it's a norm and suddenly because there's a word for designated driver therefore this must be a normal and common behavior extraordinary potent and this kind of thing leads me to become increasingly fascinating what I occasionally called mano ideas which are minimalist oblique of non-obvious interventions human behavior is a individual human behavior never mind mass human behavior is a complex system in complex systems there isn't necessarily a huge connection between the scale of the intervention and the scale of the affair strangely the human brain understands this in some domains we understand baby bio we understand that when we're dealing with plants adding a very small amount of some trace element can have huge effects on the health of the plant if you talk about economic problems or business problems for whatever reason the mental model our brain leaps to is that of kind of mecan't Newtonian mechanics where you know the scale of the effect is proportionate to the scale of the intervention I think that's a fundamental mistake so what I'm saying is that if we can get better at understanding the properties of human decision-making we will get better at changing human behavior for the better now what Marx spotted just before me and I will never come up with anything as good as that in my working life is that you had a fundamental problem which is that when it came to new syringe old syringe the bad decision was easier to make than the good decision it was human beings are naturally lazy it was easier to do the wrong thing than it was to do the right thing it's also cheaper to do the wrong thing than it was to do the right thing he changed the choice architecture so it became impossible to do the wrong thing and changing the choice architecture of things changing the way in which we present choice to people or in which we make choice available to people strikes me as an absolutely fascinating area of discovery now I'm sort of I'm not a libertarian but one of the quibbles I also have with libertarianism is it's all very well saying that people must be free to choose but it's the choices they think of a massively limited or the choices they're offered a hugely limited then that freedom of choice isn't particularly valuable to us as human beings it becomes kind of placebo choice I don't know if you know what a placebo choice is basically that thing where you're given a choice to make it feel like you've got a choice but really you haven't got a choice at all I'll give you a few examples still or sparkling in a restaurant brilliant and highly profitable phrase because once you say still or sparkling it's much harder for the person to say no tap okay um red or white which basically means you can get to drink a drink you may not like very much but you get to choose what color it is okay Kings name you said red or white are the three most depressing words in the English language what you're actually doing is you're giving the appearance of giving someone a choice so it's plain and spicy papadums may come into the same category I'm not sure um you're giving the appearance of giving someone a choice while actually closing choice down because what you're really saying when you say red or white is not I'm going to give you a lovely choice of alcoholic beverages it's don't get any fancy ideas about general gin and tonic mate okay because I don't stretch to that you bastard okay now what fascinates me i I intend to illustrate actually I think we're really really bad at choice and one of the reasons I suspect we don't have free will as a species is that if we did have freewill I think we would have got better at exercising it um but I intend to illustrate this fact with the m20 heading west from dover towards the m25 and as anybody bill we missed the m25 turnoff when coming yeah okay five six seven eight people you you have as well yeah but I got one hand up in the audience when I was in Johannesburg so this is obviously not a rare problem okay now I I've got a flat in deal and after I'd missed the turnoff for the fifth time I thought this is a bit weird okay you may be a total idiot but this is more than coincidence now I don't generally miss motorway turn offs and this one was proving to be just an absolutely recurrent nightmare so I hadn't got a clue what was happening so I went to Google Street View and I kind of you know in a kind of CSI style reconstruction I went back over the road now this is the first sign you get notice there's no distance indicator doesn't tell you where this junctions going to occur and it also says London on both sides of the road and that's the first clue you've got that you may have to do something you can't you can't make any sense of the bloody thing because Lewis Sherman Swan Lee Swan Lee's principally famous as the name of the interchange that you're heading towards so which direction that's going to be in is a bit of a mystery utterly useless information but I don't understand that bloody sign at all you think subconsciously but I can see another sign on the horizon you can probably just see it against the sky so what I'll do is I'll drive towards that sign and I'll make a decision when I get there but I've got some more information which I can actually act on so you don't thank God for that there's another sign coming as you drive towards it this happens before you can actually read the side the two lanes diverge so the fact that you've made this mistake is entirely excusable because here the only way of now correcting your mistake based on the information provided by the sign is by performing an illegal maneuver at extraordinary risk to yourself by swerving at high speed across the painted section of the motorway which I must admit I've done once okay now what fascinates me like this what it reveals I think about the human brain is that when we're presented with ships choice we don't actually notice you see I spent ten years of my life studying choice architecture and it still took me seven or eight minutes on Google Street View to go hold on a second this is bonkers nobody actually drives through that and goes this sign is stupid it's in the wrong place they just make a bad decision and when we're presented with bad choices we don't go that is a bad choice we get we just it must be some evolutionary thing that most of the decisions on the Savannah were kind of real time decisions and we just have to make the best of the present opportunities available to us hypothesizing other possibilities like moving the signage wasn't really a mental strength to be cultivated a million years ago and I've got a contention that there's a kind of weird movement I'd like to start which is like proactive libertarianism which isn't just promoting freedom of choice it's actually creating new choices for people to make now I'll give you just a little example of this I personally think that Britain should move to a four-day week in fact I wrote in The Spectator saying anybody who wants to win the election outright could just propose a four-day week and they win it's only because that every government politician is in the grip of Stu carnivai economic forces to be honest obsessed with growing GDP that this obviously leisurely and pleasant solution can't be adopted um but why don't we do it anyway and the answer is partly by the way a really simple one no one ever asked when there is never appointed our life in which we are actually presented with the option of having more leisure instead of more money so I want to do an experiment at Ogilvy which is my employer which is just to set a rule which is everybody who's worked there for two years or more every time they're offered a pay rise they must be offered the option of taking half of it as money part of it as leisure and I want to see what happens because the reason nobody is doing that maybe the reason nobody's doing it is you never asked that oldest explanation for why humans failed to do things and what fascinates me about a lot of these solutions is their what I call obvious only in retrospect I spent years accumulating more and more electronic devices so that when I travel no mobility as those nonsensical thing it means basically every time Apple or somebody invents a new mobile device it means that the bag I carry around with me gets even heavier to be honest um but every time a new one of these things came out I bought a new adapter plug for foreign you know for backward countries that don't have the proper British plug systems and um I something had about five of these and I'll throw you accumulated five of them it suddenly occurred to me no no you only need one and you carry a four gang of the extension lead with you in your suitcase and what's interesting is I wrote about that in The Spectator I got about a hundred emails from people go never occurred to me why did I never think of that it's an idea that's kind of obvious in retrospect now I've told you you'll go to it's perfect most hotel rooms only have one damn socket anyway so actually it solves that problem where you're going rounds of unplugging the television in order to charge your phone um but it's one of those things which is only obvious in retrospect and these things fascinate me first of all choices just disappear probably one of the greatest alcoholic drinks you can buy in terms of pleasure per pound sherry nobody has ever thought of buying she has anybody have thought of when we've gone into the last wine merchant even contemplated buying sherry probably about two people in the room Britain would have drunk about 100 million bottles of the stuff every year only about 30 or 40 years ago why did it disappear I think the consumption occasion just disappeared it's not the pleasure got any worse it just got kind of lost to mental salience e other things in terms of choices that we only make when we know we can make them they this thing the orange line what kids call the ginger line technically called the overground um most of that line has existed for years and years and years okay but North Londoners cannot mentally function except by using the Tube map have you noticed this because North London's don't understand South London at orgas they go I don't understand how people get around truth is that South London has lots and lots of trains which don't appear on the map and the overground line is a perfect case of brilliantly creating economic value simply by making people aware of a choice they didn't know they had so when they actually put it on the Tube map color did orange and called it the overground they did a bit of fancy stuff with new rolling stock and extend it a bit but most of it is existing for 20 years of the thing called silver link Metro for people who have been trained nerdy okay when they put it on the Tube map and called it the overground usage tripled the reason people were using it was weren't using it was a choice they didn't know they had and this strikes me as a fascinating area of just general explanation because this is the most beautiful one I can give in the medical field for years Nia's doctors GP is a pretty intelligent people by and large I think we can assume can't we we better say that because we're actually the Royal College of General Practitioners ah we had a bit of trouble getting here by the way I rang this morning and asked for directions they tell me to ring back tomorrow at 8 a.m. jokes okay anyway um oh okay anyway um pretty bright people okay but they assume that when a patient came in and said can I have antibiotics for an upper respiratory tract infection they just assumed there was a choice they didn't know they had they just assumed there were two choices give them a subscription for antibiotics don't give them prescription for antibiotics someone and I can't find out who but it seems to be in comparatively recently invented the deferred prescription you give them a prescription it becomes alive in let's say four days time and the doc simply says take this prescription away if you're still feeling crook if you're not feeling any better it doesn't have to be an Australian doctor if you if you're if you're still feeling a bit ill in four days time take this into the chemist okay and get some antibiotics now what's so important about that if you give people an immediate prescription about 98% of people take antibiotics give people no prescription I think it's still about 15% because they come back and get a second second appointment you give people a deferred prescription it's about 33% now if you factor in the fact that actually what potentially those prescriptions are unnecessary you've probably reduced the unnecessary prescription level for about 80% to 16 now what you only realize I'll be very quick here is that what nobody realized when they thought those there a few choices an immediate prescription for antibiotics contains within it a biased choice architecture and the reason is okay think about it like this you're feeling ill you get up to go to the doctors alright and you're still feeling a bit crap and so you go to the dock and the dock gives you a prescription for antibiotics now when you leave the doctor's what immediately is outside the doctor surgery a bloody pharmacy so yeah well I might as well cash this in now okay or you go to boots next dogs you don't want to make a second trip because you're planning to wrap up with a bit of lemon sip and a duvet and watch Trisha and pointless right so you cash it in you pay 8 pounds 10 for a prescription charge once you've paid for the damn pills sunk cost bias you're going to take them aren't you that's why 98% is so amazingly high so you only realize the implicit bias in the choice architecture when you realize that there is another choice now I'll give you an example of this very quickly um when you go to a restaurant none of you are aware to the extent to which you're being manipulated okay you arrive at the restaurant you sit at a table the restaurant wants to sell you wine because wine has no known price point so you can mark it up like a bastard right people kind of know what Johnnie Walker red costs so there's a limit to how much markup you can change buy a bottle of Chateau Lips cure for six quid and charge 30 for it and actually people would just rat rave about how marvellous it is and what good value it is because they haven't got a clue now you arrived they want you to break dry wine now what they do they arrive you sit down at the table and they're already wine glasses on the table okay and then they bring you a drinks list but it's not called the drinks list it's called the wine list and if you notice the choice architecture or wine list they're about nine pages of gratuitously wide selection of wine and then for the deviants perverts and transgressive there's one page at the back for people who actually want to drink spirits or beer like civilized Northern Europeans right okay so there's a huge bias of the tourist architecture but wait for the brilliant bit of genius they only hand out one wine list there's only one alcoholic drink where one person can choose for the whole table so the second that bugger with the wine list says to you red or white it's game over for anybody who wants to drink gin so what you you you're sitting there happily thinking gosh isn't it marvelous to live in a free market with all this freedom of choice and meanwhile the restaurants done you over like a bastard frankly now that's the point marketing very quickly I'll wrap up now to the things flashing another opportunity it's assumed by economists that you can't get people to make more efficient use of GPS time without financial incentives and because you can't charge for a visit to the GP how do you get people who are free all day to take appointments in the middle of the day and people have to work to go in the morning or the afternoon Cardos already solved that problem quite often just look to consumer capitalism consumer capitalism is like the Galapagos Islands of understanding human behavior okay it's got all these foibles and absurdities and if you actually ask questions about all they do is when there's already a delivery in the area they don't reduce the price of delivery at all they just make the van green and people are indifferent go well I'm not really bothered whether it's nine o'clock in the morning or 11 so I might as well choose the green one because it just seems a bit nicer Accardo wouldn't tell me the formal results they just said we could not believe how effective that nudge was do that with GPS appointments you can yield manage GPS abundance I've mentioned the red pills don't give people 24 white pills if you want them to finish the antibiotics give them 20 white ones and four red ones and say when you finish the white pills take the red ones that makes it easier to do the right thing in system one than it needs to do the wrong thing designing for our instinctive evolved psychology and also test totally stupid things the forces of reason are actually quite dangerous okay people have been trying to compete with coca-cola one minute more as I go back my more people have been trying to compete with coca-cola for about 150 years right and if you went to an economist they'd say well there's one way to beat coca-cola in the soft drinks market you got to produce a nicer tasting drink that costs less and comes in a really large container so people get value for money the only person who's successfully competing with coca-cola these people it tastes disgusting cost a fortune and comes in a tiny cap now the reasons for that are deep and deep in human psychology by the way if we want to believe a drink is efficacious in some way it has to taste a bit yucky I was talking to someone who works for a household cleaning product it's perfectly possible to manufacture a fly spray that smells beautiful no one will buy it because they don't believe it it's to basically cognitively confusing basically if I spray has to smell a bit crap because I go yeah well if it's a bit crap to me it must be a bastard to the fly that's designing for system one okay and economists don't do that economists designed the world for system two as they were reasonable finally I think this is my last slide can I just have one minute okay when people design booze and diet programs okay you go to an epidemiologist and you say okay how many units should people drink uh you know every week and suspiciously they always come up with a multiple of seven I mean it suggests that the science isn't entirely robust um but their idea is the amount you should drink they look at some epidemiological study and say well people who drink less than this don't seem to come into any harm generally so we'll make it that and that's the rational solution the system one solution to behavioural change is probably different it's probably more akin to the 5:2 diet for example do not drink for three days every week preferably consecutive days then don't worry about what you drink the other four similarly with dieting and religions basically solve this problem they called it fasting okay now the interesting difference there is you go but that's not rational because it doesn't have a clear kind of mathematical you know point of origin the logic chain on epidemiological study - don't drink three days a week actually gets broken doesn't mean it's not a better idea let me explain if you practice say a 5:2 diet or if you practice not drinking three days a week there are a lot of ways in which it's far better than counting units it's far harder to delude yourself Immanuel Kant said it is easier to fast than it is to diet okay Kant deluded himself he limited himself to one pipe of tobacco a day after breakfast but by the end of his life his pipes are absolutely bloody enormous right so if the world's foremost ethical philosopher can con himself there's no chance for the rest of us um we can delude ourselves that that vast sort of quarter liter bottle of Chilean Merlot at 15.8% is one unit okay when it's abstinence you can't con yourself in the same way secondly okay units require you to stop drinking when you're already a bit pissed oh sure I've just reached why so anyone not going to happen right thirdly if you look at man as a social animal you realize that um fasting or two days a week off or three days a week off is socially reinforcing if you and your partner choose the same two days you can help keep each other honest by going to the cinema not going to the pub units will never be socially reinforcing we all have good friends but nobody has a friend who's such a good friend that you go out to a party and they go I've actually got nine units left this week but I know you've only got two so I'll just have two drinks to keep you company not going to happen right so in all manner of other complex ways religion came up with a better heuristic system one answer than science now I think I'll end here the final thing is as I mentioned with redbull one of the marvellous things about capitalism okay I know I always wind up academics with this is that in order to succeed in academia you have to be really intelligent but the brilliant thing about business is you can succeed in business by being stupid and lucky now that's much more democratic the fact that it's convex to luck I know academics hate business people because they go but they're really stupid I know that's what's brilliant about it okay all right having really miss to us here but seriously being stupid in business can be a huge advantage because you do the things that no sensible person would do and sometimes they work and you get rewarded for it so I'll just end up with this little thing of built-in randomness which i think is a final little tip everybody in in the rational world of science believes there's a single right answer and they get skating called best practice or the optimal solution okay or maximum efficiency nature doesn't do it that way it actually builds in a degree of inefficiency or short-term inefficiency a certain significant percentage of bees ignore the waggle dance and people look there and thought that's a bit strange you'd think that to maximize pollen collection efficiency that evolution would have created a higher level of compliance then they model it mathematically undiscovered without the random bees the hive will get trapped in a local maximum and when the layout of the availability of pollen changed the hive will get stuck and starve to death there is a degree of healthy variation and inefficiency in any system and there's a degree of randomness in any system which is necessary in order for you to get lucky and so that quest which I think science always looks for which is the single right thing to which all people master dear it seems wonderful but it also comes at a cost because you never find anything out by accident that's a bit of a reading list that's me thank you very much indeed pleasure if you're dogfish they are over Longley brilliant has ever Rory I just got one quick question with like a 20 second slot for an answer okay we're about to hear from the National clinica National Clinical Director for innovation for the NHS in England is there one suggestion one nudge you think he should take away and go and implement I'll give one example which I didn't have time to talk about one of the things I've been a passionate ethics um don't discount the value of luck in the discovery process one of the things that most fascinated me was the hostility to e-cigarettes because we don't know if they're good or not okay let's be honest about this we don't know for sure but it's possible that completely unintentionally actually is the work of weird entrepreneurs in China not as the product of you know a pharmaceutical company someone's come up with the best cessation device in 100 years so the fact that people rejected that idea not because it didn't work in fact they contrived all manner of ludicrous post rationalizations to ban them like you know it promotes the image of or whatever but because it came from a source where solutions weren't supposed to come from struck me as really really alarming in other words had a pharmaceutical company came up with the ecig it would have been heralded as a magnificent you know improvement and a fantastic advance okay but because it came from left field the instinctive reaction was to throw it out that's really scary because hell of a lot of first of all a hell of a lot of improvement in life is just damage limitation you know it's just making things less bad okay that's the first thing and a hell of a lot of it's actually the product of just you know selection acting on random forces so you stay make it possible for yourselves to be lucky that's the look that's the final bit of advice Thank You Rory pleasure oh thank you very much you

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Keywords: accident, emergency, crash, health (industry), emergency department (hospital), surgery, police, ambulance, healthcare, health, medical, medical research, research, scientific research, scientific, science, medicine, talk, full talk, full, presentation, speech, Wired uk, wired, wired magazine, wired video, David Rowan, pop culture, politics, business, conde nast, technology

Id: aRxq_E0SWzs

Length: 27min 52sec (1672 seconds)

Published: Thu Apr 30 2015