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.
The rate of compliance with treatment of those who were bribed increased from 69 percent to 85 percent, while that of the control group, who received no bribe, remained almost the same. Between five and six times as many patients in the bribed group took all their injections as in the control group.
What the paper did not notice was that, for those bribed patients who did not take all their injections, the bribe made practically no difference in the number of injections they took. In other words, 18 of 75 patients changed their behaviour considerably as a consequence of the bribes but 57 did not. This probably means that the dose of money will have to be upped if better results are wanted. I suppose this should surprise no one. The mad are different from us, but not that different.
The trial was too small to detect whether bribes at this dose affect the rate of hospitalization favorably. Patients who received bribes, however, had “more favorable subjective quality of life ratings.” Whether this was because their schizophrenia was kept under better control, or because they could buy more of what they wanted (cannabis, for example), the paper does not allow us to say.
If a drug company pays a doctor to prescribe a drug, it is a bribe. If a doctor pays a patient to take it, it is a financial incentive. A rose by any other name would not smell as sweet.