How information influences behavioral change: A McDonnell Foundation workshop

A mostly-forgotten 1973 Italian film, Bread and Chocolate, takes its title from two beloved components of human diets. Achieving weight loss should mean eschewing chewing either. What lessons can be gleaned from the anecdotal evidence that the current popularity of low-carbohydrate diets, which require us to give up bread but retain the ability to have a little (dark) chocolate, is because they seem less punishing than low-fat diets (keep the bread; lose the chocolate). Why are the Atkins and South Beach diets sweeping the nation in a way low-fat diets are not, despite the evidence that individuals lose weight on either? What makes a low-carb diet seem more appealing than a low-fat diet? Both diets require us to give up foods we love; and when the diets succeed, they succeed for the same reason - because following the rules decreases daily caloric intake. The diet dilemma is an example of a more general question: what makes one idea take hold in popular practice (“pop”) while another idea, apparently of equal merit based on the available knowledge, languishes? Another way of posing this is: What factors influence whether we will or will not alter our behaviors when confronted with information?

Answering this question is of more than theoretical interest. Our ability to understand the factors positively or negatively influencing behavioral change affect the success or failure of efforts at social action, involving everything from improving human health to reducing our footprint on global environmental.

Some behavioral changes seem quite easy to obtain. The, emergence of fads in music, art, or clothing seem to occur overnight. Such rapid changes perhaps have not received a great deal of scientific attention; but their importance has been increasingly recognized in economics and in the social sciences, where interest in imitation and social norms has been recognized as central to understanding human behavior- such as patterns of consumption and drug abuse, the emergence and robustness of racism and caste structure, and other phenomena. Indeed, antibiotic overuse, smoking, and over-consumption – be it of food, alcohol, or drugs, are case studies in point where behavior seems incredibly resistant to change. Why? In some cases, this inertia can be explained in terms of selfishness-- the interests of the individual trump those of the society, and the individual is in control. In such cases, there is a role for government action to benefit the wider society, for example through incentives and disincentives, or –where weaker incentives fail, through laws.

There is another class of cases, however, best exemplified by studies of changing the treatment and management of medical trauma, where the interests of the individual (the level at which benefits accrue) may be paramount, but where changing the practice of physicians and other medical professionals (the level at which change must occur) in response to knowledge meets with an inertia or momentum that is at times difficult to understand.

The answers to these questions are intertwined with answers to what maintains social norms, and what governs changes in practice. As evidence mounted about the individual and societal costs of cigarette smoking, what caused shifts in attitudes, and why did these differ among different nations? How did efforts at regulation and behavioral modification depend upon the social contexts of the relevant countries, and attitudes towards other issues, such as individual freedoms? Similar questions exist for other issues, such as abortion rights and gay marriage, and obviously are deeply influenced by and in terms influence social network dynamics.

Because of the importance of these issues for creating a better society, and because the issues are of profound intellectual interest, the McDonnell Foundation proposes to convene a small workshop to consider what we know, and what we need to know. This workshop well might lead to follow-up activities of broader scope; but the idea initially will be to focus on medical practice, and in particular on diet, antibiotic use and trauma care. The plan will be to bring together a small but diverse collection of broad thinkers, with the goal of assessing the potential for elucidating the key issues, and providing hope for improved health care.