Stickk.com — UPDATE

Two weeks down and ten to go in my effort to lose either weight or face. Check out stickk.com where you can make any kind of commitment you like, and put something of value on the line should you fail. (Okay, in my case it was just my reputation.)

Here’s a description, straight from their FAQ:

stickK is a web-based company that helps you achieve your personal goals through “Commitment Contracts.” You create a contract obliging you to achieve a specific goal within a specific time-frame. By doing so, you put your reputation at stake. You may also choose to wager money to give yourself added incentive to succeed. If you do succeed, you get your money back. If you fail, the money is forfeited to charity, or to one of several causes, or to a person of your choosing. stickK’s services are absolutely free.”

The theory is sound — losses loom larger than gains + people have episodic moments of lucidity regarding their future — and the site is nice. By the way, I’m down a smidge over 4 lbs. So far, so good…

Open for Business — stickk.com

It’s official: stickk.com is open to the public for commitment bond business! Be sure to check them out.

Risk Aversion — Bees Do It Too

Nice op-ed piece by Michael Shermer in today’s LA Times. The main point (of both the op-ed and his nifty new book, “The Mind of the Market”) is that people aren’t fully and consistently rational in how they deal with money.

When it comes to dealing with gambles, Shermer notes that monkeys behave a lot like humans: they tend to be risk averse (i.e., prefer a sure thing over a gamble with an equivalent expectation). He goes on to wonder in awe about a common evolutionary thread that would lead us and our primate relatives to share this feature:

It is extremely unlikely that this common trait would have evolved independently and in parallel between multiple primate species at different times and different places around the world. Instead, there is an early evolutionary origin for such preferences and biases, and these traits evolved in a common ancestor to monkeys, apes and humans and was then passed down through the generations.”

What Shermer fails to note is that risk aversion is exhibited in far more than just humans and other primates. Bees, for example, have been pretty thoroughly studied; when it comes to foraging, they’d rather have a sure thing than taking a chance. This probably means there’s something pretty fundamental when it comes to attitudes toward risk.

P.S. Steep discounting (i.e., preferring a sure reward today over a sure reward later) is another potentially “irrational” approach to decision making. It was first studied in pigeons (at the Harvard Pigeon Lab) back in 1967.

Commitment Bonds Meets Inspector Gadget

SnuzNLuz — equally funny and phony: a WiFi-enabled alarm clock that donates money to a charity you despise whenever you oversleep. Cute.

UPDATE — stickk.com

So far, so good. To date, I’m down 4.4 lbs. (I did have two dinners out in a row, so I am expecting a bump up.) As far as I know, stickk.com is still in beta (i.e., invitation only), but will let you know when the site is launched to the public. Until then, you can cheer / jeer me on here.

Drug Sampling Skewed Toward Insured and Wealthy, Study Says

A study released earlier this week found that wealthier patients and those with insurance were more likely to receive free drug samples than poorer patients and those without insurance. The study appears in the February issue of the Journal of Public Health.

This isn’t necessarily surprising, because poor people and those without insurance are almost certainly in the minority among those visiting a physician’s office. In fact, the study cites differential access as a major source of the problem; uninsured patients are more likely to seek care in hospital emergency departments, for example. It’s also possible that factors associated with wealth (e.g., age) are also associated with health conditions where sampling more frequently occurs. Regardless, 13% of insured patients received a sample during the year, compared to only 10% of the uninsured.

“Our findings suggest the free samples serve as a marketing tool, not a safety net,” said study author Dr. Sarah Cutrona, as reported by Reuters.

Given the economic incentives currently in place — for drug makers seeking to capture market share, for busy physicians trying to meet patient demands, and for patients who bear the minority of the total cost of the prescription drugs they use — should we be surprised?

As always, these opinions are mine alone.

Twins Getting Married — Simply an Accident?

The story is all over the news: a British couple fall in love, get married… and subsequently discover that they’re twins separated at birth. Reports noted that the couple “felt an inevitable attraction” for one another.

After we’re done feeling squeamish, we ask ourselves, “What are the chances?”

Human disgust over incest poses an interesting puzzle for evolutionary scientists. If it weren’t for the health problems associated with inbreeding (mostly due to the increased risk from recessive genes and common weakness to pathogens), marrying within your family would make a lot of sense — set aside your revulsion for a moment — from the viewpoint of your genes. After all, what’s in your genes interest is to maximize the long-run prevalence of those genes, regardless of within which organism those genes reside.

In other words, genes aren’t a way for people to make more people; people are a way for genes to make more genes.

It’s this “selfish gene” point of view that explains a good part of altruism, especially toward one’s close family members. In general, degree of altruism is directly related to degree of kinship (this is known as Hamilton’s rule). This association between altruism and kinship helps explain the highly cooperative nature of social insects such as bees within a hive, who quite closely related. (Why humans cooperate above and beyond their degree of kinship is an especially interesting question.)

Thus, our disgust at the idea of a brother and sister getting married is thought to be an important mechanism that’s evolved to balance out our inclination to share, care for, and even subjugate our needs to our close relatives, and the cost that would be incurred due to inbreeding. In other words, if it weren’t for the “yuck” factor, there’d be a lot more brothers and sisters hooking up.

That explains the why behind revulsion concerning incest. But the question of how has been a bit more mysterious.

A recent study in the journal Nature by Debra Lieberman, John Tooby, and Leda Cosmides suggests that humans have developed a “kinship estimator” that triggers (among other things) sexual aversion to siblings — the yuck factor. What’s interesting and relevant to the twins case in England is that the two cues that are integrated by the kinship estimator are 1) awareness of one’s mother caring for another child, and 2) duration of coresidence. That is, if you see your mom caring for another child, and you grow up with that child, sexual aversion kicks in — even if you’re not related to the person for whom your mother is caring and the kid with whom you grew up. This may explain why step-siblings marry at an attenuated rate, even though they don’t run the risk associated with recessive genes, etc.

The twins in England were separated at birth and raised in two separate households, robbing each of them of both cues suggested by Lieberman et al. No cues, no yuck factor. In fact, from a evolutionary point of view, we should expect twins separated at birth to be more attracted to one another than by chance alone.

As always, my opinions are mine alone.

Should Charity have an ROI?

Denise Caruso’s recent article in the NY Times suggests that not-for-profits have gone too far in applying metrics to determine what activities to fund. The argument apparently goes something like this:

1. If one demands metrics of success, one focuses on near-term versus long-term outcomes; they’re easier to measure.
2. Many of the most important problems are long-term problems.
3. Therefore, agencies that demand metrics of success are likely to underfund initiatives to address the most important problems.

At least I think that was the argument; it was a bit hard to tell. Paul Shoemaker, a Microsoft refugee who now heads up he Seattle affiliate of Social Venture Partners International, took a different tack at why demanding measures of success is a bad idea:

“The reason the nonprofit sector exists at all is because it can fund and invest in social issues that the for-profit market can’t touch because they can’t be measured. The nonprofit ‘market’ is not designed to be efficient in that way. Yet we’re applying the same efficiency metrics to both sectors.”

This seems a bit over the top to me. Are not-for-profits really supposed to limit their activities to those with no measurable output? How would one know whether a problem even existed, let alone whether things are getting better or worse, without some sort of measure?

Indeed, Tim Harron (the “undercover economist” for FT) notes that tough social issues can be tackled using randomized controlled trials. Pretty impressive stuff — not only are outcomes being measured, but they’re being tied to interventions in the most scientifically sound manner.

Stickk.com Update

I am fortunate enough to be an early member at stickk.com, a new “commitment bond” website co-launched by Yale professor (and “Super Crunchers” guru) Ian Ayers. As noted in a previous post, I put a contract on myself to lose 11 lbs in 12 weeks. Two updates:

1. I’ve lost 2.4 lbs to date. I am well ahead of schedule but may have hit a little plateau… we shall see. I am using the lowest dose of a commitment bond, with nothing my my feeble reputation on the line. You can watch me lose either weight or face here.
2. The latest buzz I hear is that the stickk.com website will be going live for all users very, very soon.

Drug Company Marketing: Who’s to Blame?

A new study out of York University asserts that in 2004, US drug manufacturers spent nearly twice as much on promotion as they did on research. The authors of the study conclude that in contrast to “the industry’s vision of research-driven, innovative, and life-saving pharmaceutical companies” manufacturers are really “marketing-driven.” The study estimated that drug manufactures spent $57.5 billion in 2004 on promotion, nearly double the amount spent on R&D.

There are limitations to the study. The authors acknowledge that they chose the high end of the plausible range as their best point estimate, with the low end being $27.7 billion). In addition, a non-negligible amount of basic research occurs outside of the industry per se (i.e., in the academic setting). These issues alone could swing the pendulum the other way.

But set those issues aside. If pharma is really “marketing-driven” and if that’s undesirable, who’s responsible? Now more than at any time in the history of pharmacy, generic medications offer a potent alternative to branded drugs. In class after class of prescription drugs — cholesterol-lowering statins, antihypertensives, drugs for heartburn, non-sedating antihistamines — high-quality generic alternatives are available. The best estimate is that 75% to 80% of all prescriptions filled in the US could be for generics.

Pharma spends a lot on promotion of existing branded products because it works. And it works because we — patients and physicians — don’t make the effort to try a good generic alternative before moving on to a higher-cost branded drug. Even worse, we’re likely to complain with our employers or health plans attempt to implement programs that promote generic drugs.

If you think that pharma should spend less on drug promotion and more on R&D, vote with your prescription. Ask for a generic alternative, and reward the drug manufacturers for those specific drugs that really offer additional value above and beyond the best generic in that class of drugs. Pharma will get the message loud and clear.

As always, these opinions are mine alone.