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| Nudge: Improving Decisions About Health, Wealth, and Happiness | 
 enlarge | Authors: Richard H. Thaler, Cass R. Sunstein
Publisher: Yale University Press
Category: Book
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Avg. Customer Rating:  44 reviews
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Media: Hardcover
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Pages: 304
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Dimensions (in): 9.3 x 6 x 1.2
ISBN: 0300122233
Dewey Decimal Number: 330.019
EAN: 9780300122237
ASIN: 0300122233
Publication Date: April 8, 2008
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Amazon.com Review
Questions for Richard Thaler and Cass Sunstein   Amazon.com: What do you mean by "nudge" and why do people sometimes need to be nudged? Thaler and Sunstein: By a nudge we mean anything that influences our choices. A school cafeteria might try to nudge kids toward good diets by putting the healthiest foods at front. We think that it's time for institutions, including government, to become much more user-friendly by enlisting the science of choice to make life easier for people and by gentling nudging them in directions that will make their lives better.
Amazon.com: What are some of the situations where nudges can make a difference? Thaler and Sunstein: Well, to name just a few: better investments for everyone, more savings for retirement, less obesity, more charitable giving, a cleaner planet, and an improved educational system. We could easily make people both wealthier and healthier by devising friendlier choice environments, or architectures.
Amazon.com: Can you describe a nudge that is now being used successfully? Thaler and Sunstein: One example is the Save More Tomorrow program. Firms offer employees who are not saving very much the option of joining a program in which their saving rates are automatically increased whenever the employee gets a raise. This plan has more than tripled saving rates in some firms, and is now offered by thousands of employers.
Amazon.com: What is "choice architecture" and how does it affect the average person's daily life? Thaler and Sunstein: Choice architecture is the context in which you make your choice. Suppose you go into a cafeteria. What do you see first, the salad bar or the burger and fries stand? Where's the chocolate cake? Where's the fruit? These features influence what you will choose to eat, so the person who decides how to display the food is the choice architect of the cafeteria. All of our choices are similarly influenced by choice architects. The architecture includes rules deciding what happens if you do nothing; what's said and what isn't said; what you see and what you don't. Doctors, employers, credit card companies, banks, and even parents are choice architects.
We show that by carefully designing the choice architecture, we can make dramatic improvements in the decisions people make, without forcing anyone to do anything. For example, we can help people save more and invest better in their retirement plans, make better choices when picking a mortgage, save on their utility bills, and improve the environment simultaneously. Good choice architecture can even improve the process of getting a divorce--or (a happier thought) getting married in the first place!
Amazon.com: You are very adamant about allowing people to have choice, even though they may make bad ones. But if we know what's best for people, why just nudge? Why not push and shove? Thaler and Sunstein: Those who are in position to shape our decisions can overreach or make mistakes, and freedom of choice is a safeguard to that. One of our goals in writing this book is to show that it is possible to help people make better choices and retain or even expand freedom. If people have their own ideas about what to eat and drink, and how to invest their money, they should be allowed to do so.
Amazon.com: You point out that most people spend more time picking out a new TV or audio device than they do choosing their health plan or retirement investment strategy? Why do most people go into what you describe as "auto-pilot mode" even when it comes to making important long-term decisions? Thaler and Sunstein: There are three factors at work. First, people procrastinate, especially when a decision is hard. And having too many choices can create an information overload. Research shows that in many situations people will just delay making a choice altogether if they can (say by not joining their 401(k) plan), or will just take the easy way out by selecting the default option, or the one that is being suggested by a pushy salesman.
Second, our world has gotten a lot more complicated. Thirty years ago most mortgages were of the 30-year fixed-rate variety making them easy to compare. Now mortgages come in dozens of varieties, and even finance professors can have trouble figuring out which one is best. Since the cost of figuring out which one is best is so hard, an unscrupulous mortgage broker can easily push unsophisticated borrowers into taking a bad deal.
Third, although one might think that high stakes would make people pay more attention, instead it can just make people tense. In such situations some people react by curling into a ball and thinking, well, err, I'll do something else instead, like stare at the television or think about baseball. So, much of our lives is lived on auto-pilot, just because weighing complicated decisions is not so easy, and sometimes not so fun. Nudges can help ensure that even when we're on auto-pilot, or unwilling to make a hard choice, the deck is stacked in our favor.
Amazon.com: Are we humans just poorly adapted for making sound judgments in an increasingly fast-paced and complex world? What can we do to position ourselves better? Thaler and Sunstein: The human brain is amazing, but it evolved for specific purposes, such as avoiding predators and finding food. Those purposes do not include choosing good credit card plans, reducing harmful pollution, avoiding fatty foods, and planning for a decade or so from now. Fortunately, a few nudges can help a lot. A few small hints: Sign up for automatic payment plans so you dont pay late fees. Stop using your credit cards until you can pay them off on time every month. Make sure you're enrolled in a 401(k) plan. A final hint: Read Nudge.
Review "How often do you read a book that is both important and amusing, both practical and deep? This gem of a book presents the best idea that has come out of behavioral economics. It is a must-read for anyone who wants to see both our minds and our society working better. It will improve your decisions and it will make the world a better place."-Daniel Kahneman, Princeton University, Nobel Laureate in Economics (Daniel Kahneman ) "In this utterly brilliant book, Thaler and Sunstein teach us how to steer people toward better health, sounder investments, and cleaner environments without depriving them of their inalienable right to make a mess of things if they want to. The inventor of behavioral economics and one of the nation''s best legal minds have produced the manifesto for a revolution in practice and policy. Nudge won''t nudge you-it will knock you off your feet."-Daniel Gilbert, professor of psychology, Harvard University, Author of Stumbling on Happiness (Daniel Gilbert ) "This is an engaging, informative, and thoroughly delightful book. Thaler and Sunstein provide important lessons for structuring social policies so that people still have complete choice over their own actions, but are gently nudged to do what is in their own best interests. Well done."-Don Norman, Northwestern University, Author of The Design of Everyday Things and The Design of Future Things (Don Norman ) "This book is terrific. It will change the way you think, not only about the world around you and some of its bigger problems, but also about yourself."-Michael Lewis, author of The Blind Side: Evolution of a Game and Liar''s Poker (Michael Lewis ) "Two University of Chicago professors sketch a new approach to public policy that takes into account the odd realities of human behavior, like the deep and unthinking tendency to conform. Even in areas-like energy consumption-where conformity is irrelevant. Thaler has documented the ways people act illogically."-Barbara Kiviat, Time (Barbara Kiviat Time ) "Richard Thaler and Cass Sunstein''s Nudge is a wonderful book: more fun than any important book has a right to be-and yet it is truly both."-Roger Lowenstein, author of When Genius Failed (Roger Lowenstein ) "A manifesto for using the recent behavioral research to help people, as well as government agencies, companies and charities, make better decisions."-David Leonhardt, The New York Times Magazine (David Leonhardt The New York Times Magazine ) "I love this book. It is one of the few books I''ve read recently that fundamentally changes the way I think about the world. Just as surprising, it is fun to read, drawing on examples as far afield as urinals, 401(k) plans, organ donations, and marriage. Academics aren''t supposed to be able to write this well."-Steven Levitt, Alvin Baum Professor of Economics, University of Chicago Graduate School of Business and co-author of Freakonomics: A Rogue Economist Explores the Hidden Side of Everything (Steven Levitt )
Product Description
Every day, we make decisions on topics ranging from personal investments to schools for our children to the meals we eat to the causes we champion. Unfortunately, we often choose poorly. The reason, the authors explain, is that, being human, we all are susceptible to various biases that can lead us to blunder. Our mistakes make us poorer and less healthy; we often make bad decisions involving education, personal finance, health care, mortgages and credit cards, the family, and even the planet itself. Thaler and Sunstein invite us to enter an alternative world, one that takes our humanness as a given. They show that by knowing how people think, we can design choice environments that make it easier for people to choose what is best for themselves, their families, and their society. Using colorful examples from the most important aspects of life, Thaler and Sunstein demonstrate how thoughtful “choice architecture” can be established to nudge us in beneficial directions without restricting freedom of choice. Nudge offers a unique new take—from neither the left nor the right—on many hot-button issues, for individuals and governments alike. This is one of the most engaging and provocative books to come along in many years.
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| Customer Reviews: Read 39 more reviews...
 The elephant in the room. March 23, 2008
124 out of 147 found this review helpful
Richard H. Thaler and Cass R. Sunstein are both professors at the University of Chicago and where the Chicago school was once famous for the Milton Friedman doctrine of free markets (look where they've got us today!) Thaler and now his Law professor friend Cass Sunstein have swung the pendulum the other way.
Here in Nudge, they argue that totally free markets can lead to disasters precisely because human individuals are not actually very good decision-makers. As Behavioural Economists (Kahneman & Tversky Judgment under Uncertainty: Heuristics and Biases- who credited Thaler as being a key inspiration - and Dan Ariely, whose Predictably Irrational: The Hidden Forces That Shape Our Decisions has become a best seller) argue, we are riddled with little psychological tics in our decision-making processes. We buy things, then suffer remorse. We get confused by choices and often make no choice at all.
But where Ariely keeps his discourse in the world of the day to day, Thaler and Sunstein develop an argument that is political - and is bound to cause heated debate. What they argue is that, in the face of our decision-making weaknesses, Governments and Businesses can help "nudge" us in the right direction. The elephant in the room can be benign.
They call their viewpoint `libertarian paternalism' and what they argue is that it would be a good thing for some gentle nudging of the citizenry in the right direction. As Thaler said recently in the New York Times: "In light of human limitations, Cass Sunstein and I argue for policies that we call libertarian paternalism. Although the phrase sounds like an oxymoron, we contend that it is often possible to design policies, in both the public and private sector, that make people better off -- as judged by themselves -- without coercion. We oppose bans; instead, we favor nudges."
How does a Government do this without imposing laws and edicts. A primary argument is that defaults can be set that counter the tendency by humans to procrastinate or make no decision. One example is the Save More Tomorrow Plan which Thaler developed back in 1996 as an employer sponsored retirement plan for employees. Instead of presenting the details and asking employees to consciously sign-up to increase their savings each time they got a pay rise, the plan presented the details and asked employees to basically check the box if they wished in future to automatically increase their savings as their pay went up. To pre-commit. Such schemes have proved very successful, yet they offer the same free choice, though with a different default.
As Thaler argues: "Since it is often impossible for private and public institutions to avoid picking some option as the default, why not pick one that is helpful?"
Another form of nudge might be the act of disclosure. Thaler & Sunstein argue, for example that credit card companies should issue annual statements that tell us how much we've spent this year on late fees and interest. Again: we have the complete freedom to use cards as we want, but the additional information may help us reframe our own spending strategies. Or how about stickers on new cars that show how much gasoline each vehicle would burn over the next 5 years under typical usage. Hold that Hummer.
These are examples of what the authors call helpful "choice architecture." Nice phrase. The architecture puts our options on more clear display.
I must say, I like the thinking here, and it gives credence to agent-based simulation modelling I've carried out whereby small changes can lead to big effects.
But this volume is about more than modelling and mere theory. One cannot help but think that the book has been timed to coincide with the meltdown of the present economy. The free market, the totally free market, the authors implicitly argue, needs quite a nudge itself. Rather than seeking highly regulated solutions, the better response might simply be a series of tweaks to the choice architecture that influences our spending, saving, health care and borrowing patterns.
The authors present a clear argument and no doubt it will cause heated and lively debate. This book has landed like a rock, right into the centre of the current and somewhat stagnant economic pond. It will definitely cause ripples. Well worth reading.
Innovative, Helpful, Relevant: Opening Shot in Science of Choice March 27, 2008
46 out of 77 found this review helpful
This is one of several books on decision-making and choice I have ordered, the first to arrive. I had no idea when I ordered it, based on the title, that the first author was Distinguished Professor of Behavioral Science and Economics as well as the Director of the Center for Decision Research at the University of Chicago, and the second author was Cass Sunstein, one of three lawyers I would not automatically sentence to exile.
I really liked this book. It can be read fast or slow. I went fast, if one accepts the authors' propositions at face value, the details are not as necessary. These guys are heavy hitters with a very serious case to present. Although I did not see references to predecessors in this area, such as Herb Simon's "satisficing," the one word I remember from my MPA finished in 1987, the bibliography and notes are excellent and I have the feeling the authors and their research assistants have been thorough with the recent literature (last 15 years).
The book opens with a compelling example: a cafeteria manager discovers that she can seriously influence students by how the food is placed, arranged, and displayed, moving an entire student body toward healthier choices (or not).
The authors term such a person a "choice architect" and say that like physical architecture, there is no such thing as a "neutral" choice. They go on to discuss the emerging science of choice. I love this, in part because I just published a book, Collective Intelligence: Creating a Prosperous World at Peace (free online at Earth Intelligence Network) intended to force acceptance of Collective Intelligence as a sub-discipline within Cognitive Science. We succeeded.
The authors coined the term NUDGE from the ardiously broken down:
iNcentives
Understand mapping
Defaults matter
Give Feedback
Expect Error
Structure complex choices
Corney, but no worse than my own United Nations Open-Source Decision-Support Information Network (UNODIN). This is an important book, and the last one, "structure complex choices," is in my view the critical one because we are in an era when our politically-elected leaders know nothing of the real world and are surrounded by advisors that are hacks who are terrified of anyone with a brain gaining access to "their" candidate. No one now running for President of the USA is qualified to date, for this very reason. Not one of them can appoint a transpartisan cabinet, produce a balanced budget, name the ten threats to humanity, list the twelve core policies from agriculture to water, or explain why we have less than six years to create a sustainable model that we can present to Brazil, China, India, Indonesia, Iran, Russia, Venezuela, and Wild Cards like the Congo, which is as big as the USA.
Leadership must be redefined, and I believe that the authors have put together a capstone book that is richly qualified to join books such as The leadership of civilization building: Administrative and civilization theory, symbolic dialogue, and citizen skills for the 21st century and Leadership and the New Science: Discovering Order in a Chaotic World and the oldie but goodie by Harlan Cleveland, still a best in class offering, The Knowledge Executive.
The authors distinguish between Automatic Mind and Reflective Mind, and I cannot help but tie this to the truly elegant essay The Future of the Internet--And How to Stop It in which the urgency of preserving generative freedom to innovate at the edge of the network is retained. I see such a convergence among all the books I am reading, and am reminded now of Kevin Kelly's unigue Out of Control: The New Biology of Machines, Social Systems, & the Economic World. The problem we face is that government and all other organizations are pyramidal, secretive, selfish, and generally corrupt--and busy trying to "lock down" the appliances, one reason I will never buy an iPhone or an XBox.
The authors explore hor people are so unrealistically optemistic about their own capabilities (and I would add, unnecessarily suspect of the other, one reason I recommend to one and all Derek Leebaert's The Fifty-Year Wound: How America's Cold War Victory Has Shaped Our World.
I agree with their discussion of the bias toward the status quo and truly appreciated their discussion of social influences (herd mentality). This is different from wisdom of the crowds, smart mobs, etc.
They have four chapters on money (savings, investing, credit, and social security), and the bottom line for all four is this: 1) it is possible to structure complex choices so people have freedom but err on the side of wisdom; and b) defaults matter.
In the section on health they discuss prescriptions, organ donation, and the environment. Here I would simply note that we know how to cut Medicare prescription costs to 1% of their existing and projected costs, but Congress is both gutless and totally lacking in ethics. I will also note that in another book I reviewed recently, the Chinese have discovered that they are losing TEN PERCENT of the Gross Domestic Product to envrionmentally-related loss of work productivity. This is serious!
In the section on Freedom their "libertarian paternalism" shows itself in full force as they discuss school choice, doctors, and marriage. I will not be critical here, other than to note that reforming education is NOT about school choice, it is about changing the entire model to throw out rote learning in neat little rows and testing of memorized regugitation. See Pedagogy of Freedom: Ethics, Democracy, and Civic Courage (Critical Perspectives Series) and Teaching to Transgress: Education as the Practice of Freedom, among others.
They end with a dozen "example" nudges that I will not list here, in part because I do like this book, it is an easy read, and it is worthy of your time and money. Do not expect a scholarly tome with lots of pretentious mathematics. This is a good book for real people, and all the more valuable because the science of choice, like services sciences and collective intelligence as a cognitive-socio-economic ideo-cultural techno-demographic force, is going to make a very positive contribution to how we self-organize and how we respond to those who would be Epoch B leaders rather than dictators that take We the People for granted.
Buy this book--it might not improve your own decisions, but it will assuredly help you think about what to look for in a leader.
See also:
The World Cafe: Shaping Our Futures Through Conversations That Matter
 A hollow and anti-democratic worldview June 7, 2008
41 out of 52 found this review helpful
My dictionary tells me that "nudge," which rhymes with "judge" and means a gentle push, is probably of Norwegian origin. The authors are careful to distinguish this from the Yiddishism "noodge," meaning pest or bore (@4). So maybe a bakkel, which is what they call doughnuts in Norway, would be a more appropriate analogy for this book than a bagel. But either way, the book is missing something at its core. And it is not as much of a departure from the Chicago School worldview as some reviews would have you believe.
1.Richard Thaler (RT) and Cass Sunstein (CS) base their recommendations on the experimental studies of A. Tversky, D. Kahneman and, among others, RT himself. As developed during the past three decades or so, these have led to the field of "behavioral economics" (and a Nobel Prize for Kahneman). The gist is that people have certain "irrational" ways of looking at the world that lead them to act differently from the way most economists assume for their convenience of their theories. By "nudge" they mean a design element in a thing or in a process that anticipates these psychological tendencies, and steers people toward behavior that, ideally, helps them without limiting their freedom.
Many of the principles and techniques they describe (which other reviewers on this page summarize) have been known and exploited for far longer than there were fancy names for them. Retailers have set at prices $9.98 rather than $10.00 since time immemorial, relying on "availability". The wisdom of writing contracts and designing business processes with "idiot-proof" procedures (the term I was taught decades ago, in lieu of "nudge") is similarly ancient, at least within better law firms and companies. So RTCS's notion that nudges could be used more often when designing social policy shouldn't be very controversial. And on their face, many of their analyses make sense.
2.RTCS do skate on thin ice near the end, when they make it explicit that they're relying on "the invisible hand" of markets to make their proposals work (e.g., @239-240) - a hand whose existence, or at least invisibility, is controversial. They're also on shaky ground when they suggest that John Rawls's "publicity principle" should be a constraint on nudges "in both the public and private sectors" (@244-245). This principle states that governments shouldn't select policies that they wouldn't be willing or able to defend publicly to their own citizens. RTCS don't spell out, though, the scope of this principle in the private sector. Should the analogue of "citizen" be shareholder, or indeed all citizens? If the latter, what's the source of this duty? If to shareholders only, where does that leave the rest of us?
3.But those are details. The deeper problem is what's missing from the big picture of this book. Namely: society.
"There is no such thing as society. There are individual men and women, and there are families." So said Margaret Thatcher, and though RTCS don't quote her, they seem to share this view. Everything in this book is focused on decisions made by individuals (called "Humans" by RTCS) for their own good or ill, and based on their own preferences. The only other entity is a "Planner", such as a legislature, bureaucracy, judiciary or corporate management. Its relationship to individuals is top-down. Moreover, the Planner's own psychological quirks are rarely discussed. In effect, the "homo economicus"-type of rationality that behavioral economics denies to Humans is shifted up one level to the Planner.
The idea that people might act together to influence the Planner, select the Planner, communicate their will to the Planner, or rebel against the Planner is totally missing from this book (aside from a passing reference in a footnote (@238). This is very much in line with Robert Reich's observation in "Supercapitalism" (2007) that collective action and debate in American democracy has been replaced by an atomistic consumerism affecting all aspects of life, including politics.
The worldview expressed in "Nudge" is a far cry from the idea of "active liberty" described by Supreme Court Justice Stephen Breyer in his book of that name (2005). Democratic participation in lawmaking is central to Breyer's view, and policy decisions should be based on facilitating that participation. OTOH, in their footnote, RTCS make the conjunction of good laws and popular will sound like an occasional happy accident: "Social practices, and the laws that reflect them, often persist not because they are wise but because Humans, often suffering from self-control problems, are simply following other Humans. ... We do not mean here to question the view that laws that really do embody the judgments of many people often deserve support for that reason" (@238n). Of course one can think of examples where what RTCS say here is right; slavery, for example. But many other cases are less clear-cut (not that RTCS even express any opinion on the slavery issue or the "wisdom" of any other human rights). This footnote embodies the entire discussion of democracy you'll find in this book. RTCS don't even specify who those "many people" might be -- "Planners" perhaps?
4.A corollary of RTCS's ignoring society is that they have no sensitivity to culture (notwithstanding numerous references to TV shows). This is most obvious in their chapters on organ donations (Ch. 11) and marriage (Ch. 15). The idea of a market for the purchase and sale of human organs "has obvious merit, [but] it is also spectacularly unpopular for reasons that are not well understood" (@175). Maybe the reason is that peoples' cultural beliefs lead them to find the idea of such a market repugnant?
Or how about RTCS's proposal that the institution of marriage be left to private religious groups, with government providing only the institution of civil union - for everyone. They don't consider the idea that a nation's laws should express the cultural values of its people. Nor do they consider whether civil unions would be accepted without stigma in society - or even within families. Since many inter-faith marriages wouldn't be recognized under the laws of any specific religion, do RTCS expect people to shop around for a more convenient religion, or give up religion altogether? Maybe someday people will come around to RTCS's ultra-rational view (which may also be tinted by the apparently divorced status of at least one of them), but we're a long way from it. They need to deal with that.
One more thing about culture: RTCS assert that Tversy & Kahneman-type psychological tendencies arise from brain function (@19), and throughout the book they use the word "Human" to describe people who display those tendencies. I'm not an expert in this area of research, but it isn't clear how much of it has relied on subjects from non-Western cultures. Previous multi-cultural studies in behavioral economics, such as "Foundations of Human Sociality" edited by J. Heinrich & al. (2004), show considerable variation across cultures. So the details of "choice architecture" may be far more culturally-specific, and less scientifically grounded, than RTCS acknowledge. Certainly the book's point of departure, how to engineer behavior on the basis of individual preferences to behaviors, is very American. It would be quite alien to many books on social policy from France, Germany or Japan, for example. BTW playing this scientistic rhetorical trump card in matters of policy is a hallmark of the Chicago School. See, e.g., James Hackney Jr.'s "Under Cover of Science" (2007), which, despite not being enitrely convincing about the historical reasons for this rhetorical trope, is entirely correct in identifying it.
5.CS was close with the Clinton Administration, and an early supporter of Obama. He's probably on the short list for a Federal judgeship - even to fill a Supreme Court vacancy - next time the Democrats take the White House. Before reading this book, I'd have welcomed such an appointment. Now, I'd be much more cautious to do so. America is a society in addition to being a group of individuals. And that society is the source of any "Planner's" authority. I hesitate to give such authority to anyone who forgets where it comes from, and forgets the values that underlie it. Unfortunately, that is exactly what the authors of "Nudge" appear to have forgotten.
Important for medical decisions as well March 31, 2008
37 out of 52 found this review helpful
"Buy on apples, sell on cheese" is an old proverb among wine merchants. Taking a bite of an apple before tasting wine makes it easier to detect flaws in the wine, and the buyer who does so will not as easily make the mistake of paying more than the wine is worth. Cheese, on the other hand, pairs well with wine and enhances its flavor, so a seller who offers cheese may command a higher price for the wine (and may even deserve it, if the wine is intended to be drunk with cheese).
The proverb captures important psychological nuances of choice. The same product - a bottle of wine or a risky medical procedure - may be perceived differently depending on its context, and it is often possible to arrange the context to influence a choice while still maintaining the decision maker's autonomy.
The practice of structuring choices is called "choice architecture" in a brilliant and important new book, Nudge, by University of Chicago Distinguished Professors Richard Thaler (Business) and Cass Sunstein (Law). Nudge lays out the groundwork for the science of choice architecture in investing, insurance, health care delivery, and other areas, and argues for a "libertarian paternalism" in which choices are structured to make it more likely that a decision maker will select what is considered the most beneficial option, without impairing the ability to decision makers to select other options. For example, making enrollment in 401(k) plans automatic for new employees, with a form for opting out, is likely to result in greater retirement savings than an opt-in system, without limiting anyone's freedom to choose.
Thaler and Sunstein apply the principles of choice architecture to a few problems in health care (How could Medicare part D be improved? How can organ donation rates be increased? Why shouldn't patients be allowed to waive their right to sue for medical negligence in return for cheaper health care?) But the concepts in the book go beyond their specific examples and could prove very useful to practicing clinicians, who, they note, are often in the position of being choice architects for their patients.
Their principles of choice architecture (paraphrased by me and focused on physicians helping patients make decisions) are:
* Make sure incentives are aligned with desired outcomes
* Help patients map outcomes of different alternatives into formats they can understand (a major focus of Medical Decision Making as well)
* Arrange default options to favor better health. Pediatricians have done a good job of making vaccination a default option.
* Provide timely and relevant feedback about choices and outcomes. A patient seeking to lose weight needs to experience feedback in the form of measurable progress soon enough that they are not discouraged.
* Expect error and develop systems to prevent, detect, and minimize it. For example, pill cases and inhalers with dosage counters are simple and valuable ways to reduce the frequent errors people make in remembering medication. Psychological research provides direction as to what kinds of errors are to be expected when people are making decisions.
* Structure complex choices to reduce the difficulty of making good decisions. In many ways, that's what medical decision making -- and Medical Decision Making -- is about.
I highly recommend Nudge. It's a great read, and has the potential to change the way you think about clinical practice and medical decisions.
A little dense and not my cup of tea May 22, 2008
18 out of 23 found this review helpful
The sub title of the book "Improving Decisions about Health, Wealth and Happiness" should have been a hint at what the book was really about which is "choice architecture" a way to further "libertarian paternalism" meaning that if choices are presented to you in a certain way, you'll make better choices and it'll seem like you're making the choice of your own free will instead of being "nudged" into making the "right" choice.
I'm a big fan of learning why we make the types of choices we make and possibly how to influence those choices. I'm also a big fan of learning how to make better choices for myself.
This book, however, leans heavily to the public policy side of things like how to get people to choose more wisely for retirement savings and the like. It really isn't about Health, Wealth and Happiness. It's about creating systems to "nudge" people into making choices they might not otherwise make.
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