Money's Effect on Medicine

I read a fascinating article in yesterday's New England Journal of Medicine. Briefly, it was an essay by Pamela Hartzband and Jereome Groopman discussing the influence that they see money having on the ever evolving practice of medicine. They describe a fascinating sociological experiment designed to test the effect of money on people's behavior.

A truck was parked with a couch close beside it on a busy university walkway. The investigators asked passersby to help. When they asked them to help them as a favor, they got a good response; however, people's willingness to help dramatically decreased when they offered passersby 50 cents to help out. If they offered them a piece of candy to help out, they got an equal response to the control group that did it as a favor. They had to offer passersby $5.00 before they got an equal percentage of people to help as when they asked people to do it as a favor. (n=614)

The interpretation of the study, which is supported by several other studies, demonstrates the effect of money on people's responses. Simply put, even the presence of money in the room affects people's altruistic inclinations. The implications for the practice of medicine are quite staggering, particularly as medicine becomes more heavily influence by business.

We need to preserve the art, the compassionate side of medicine, while also embracing the reality that we are running a business. This has been a significant conundrum for medicine over the centuries. While typically history would have many lessons, I'm not familiar with a time where medicine has been as complex and expensive as it currently is. Only a small percentage of individual patients with significant medical problems could cover the true cost of care on their own. Clearly, we need some kind of cost-sharing system, but the best model has yet to be determined. I'll be following Tom Daschle's proposals on how to improve our health care system with great interest, assuming he is confirmed as HHS Secretary, which is still under review by the senate committee.