Can Money Become Medicine?
Should patients be bribed to take their pills?
November 5, 2013 - 5:30 pm
Not long after I suggested satirically that money might be the cure for the terrible disease of burglary, experiments were performed to bribe drug addicts into remaining abstinent. I had suggested that money was a genuine pharmacological treatment of burglary because there would be a dose-response relationship (the larger the dose of money given to burglars, the greater and longer-lasting their law-abidingness) and that, as with most drugs, there would be treatment failures. Some burglars are more interested in the excitement of burglary than in its material rewards; money would have little or no effect on them.
It turns out that money as a drug is a bit like aspirin: it can be used for many illnesses. The fat have been bribed to lose weight; the drunk to stop drinking; the diabetic to take their pills and stop eating sugar; the smokers to stop smoking; and the indolent to start taking exercise. It’s enough to make you wonder whether there is anything that can’t be cured by money. The latest disease to yield to money’s curative, or at least alleviatory, properties is schizophrenia.
Medication can improve this condition but unfortunately patients often do not take it for long and then relapse. This is partly because they do not accept in the first place that they are ill and partly because the medicine they are supposed to take has many, and sometimes very disagreeable, side effects.
To counter the propensity of schizophrenic patients not to take their medicine, long-acting injectable forms were developed; but it is easy for schizophrenics not to accept them either. Researchers in England and Switzerland wondered whether, if patients were bribed to take the injections, they would do so with greater regularity. Their trial was a small one, involving only 131 patients, divided into those who were offered a bribe (in the paper, published recently in the British Medical Journal, it is more delicately called a financial incentive) and those who were not. The bribe was not large, $22 per monthly injection; but it must be remembered that most of the patients were probably unemployed and living in relative poverty. There are still people in our society to whom $264 a year would be well worth having.