One problem faced by a society that is always working toward solutions to various problems is that certain solutions, however effective, may go unused because they cannot be commodified.
Consider obesity. True, billions of dollars have been made selling all sorts of diet and exercise and weight-loss products, but perhaps the best solution is the free one: eat a bit less and a bit better and take a good 30-minute walk every day. But it’s hard to make money pushing that idea.
In this interview with The Takeaway, the author and surgeon Atul Gawande offers another compelling example. Gawande’s new book, The Checklist Manifesto (see Levitt’s strong endorsement here) describes his effort to create a checklist for use in surgical settings that could cut down on errors.
The checklist, piloted in eight hospitals around the world, proved to be very successful. It was also essentially free. But, as Gawande explains in the Takeaway interview, widespread adoption has been far slower than he would like. Why?
If a pharmaceutical company came up with a drug or a device that offered the same improved outcomes as the checklist, Gawande notes, that drug or device would be worth billions of dollars, and would be marketed accordingly. The lowly checklist, meanwhile, has no such sponsor and therefore is far slower to spread.
Here’s hoping that the checklist, along with other cheap and simple solutions, can somehow keep worming their way into the marketplace, despite competition from much better-promoted (and often inferior) ideas.
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I think of this sort of thing whenever I see credit card commercials.
There’s no advocate for cash, so it’s demonized
Shouldn’t insurers want to champion a reduction in errors?
The solution has no price because the underlying problems are priced into the service provided. If current practices are providing a sufficient rate of return to the firm, there is little motivation to confront the inevitable protests that accompany imposition of “cost-cutting” measures. Those “cost-cutting” measures like reduced professional liability insurance premiums, legal fees, etc., place the burden of execution on the worker, but the rewards accrue to the shareholder. If the checklist could be tied to an incentive for the worker in such a way that they could receive a portion of the savings, I think that “price” would be eagerly paid by the firm.
And that was a great book, I’m trying to create a DO-CONFIRM list for some of the things I do.
Your advertisers state that “you get what you pay for…” and market so readers covet and purchase what they don’t need and at inflated mark-ups. Your paper’s other columnists adopt a “there’s no free lunch” hubris about anything the public finds overpriced. Our culture has been inoculated against common sense by media.
Therefore, thanks for this article – a breath of fresh air. Dr. Gawande is a breathe of fresh air!
“…widespread adoption has been far slower than he would like. Why? ”
Why? I think the answer is obvious: if it’s ‘free’ then no one stands to make money off of it. This disincentivises a large number of people in our country, and certainly keeps any corporation from promoting it. Actually, now that I think of it, the fact that a good solution is free might actually increase the likelyhood of a corporation actively working against a solution should they have a different and maybe less effective solution.
The same is true with the “obesity epidemic”.
“But it’s hard to make money pushing that idea”
Nonsense – as the endless stream of books like this shows, it’s one of the easiest things in the world to make money pushing the idea of healthier diets and exercise.
Now, if the advice in any of these books were accurate, _and_ people decided to follow it – that’s when it _would_ get hard to push it. But that’s unlikely to ever actually happen because (whether your taste is for natural selection or conspiracy theories) the only books along those lines that ever get published are the ones that people buy, read, and ignore.
What’s stunning is not slow rate of adoption — it’s that they weren’t already doing this in the first place.
Operating without a checklist? That’s medieval.
There are many many problems in the world that could be solved for “free” simply by convincing people to modify their own behaviors.
Of course that’s much easier said than done, given that people do not always act in their own self-interest (as Malcolm Gladwell and others have shown), and often have difficulty figuring out where their own self-interest lies.