Blame It On the Old Me

New research from Johns Hopkins suggests that if you want to have better habits, you probably should have made better decisions in the past.

Millions of mothers are probably now thinking, "I told you so!"

The research conditioned participants to associate red and green objects on a computer screen with small financial rewards ($1.50 and $0.25, respectively), then had them perform another task to find certain shapes on the screen, with no reference to color and no reward.  By using a PET scan to monitor brain activity, the researchers found that, instead of focusing on the new task, the participants' attention was still drawn to red shapes.

As the authors concluded,

What's surprising here is that people are not getting rewarded and not expecting a reward.  There's something about past reward association that's still causing a dopamine release.  That stimulus has become incorporated into the reward system.

This will not come as a surprise to anyone who has ever had a donut.

Of course, we've known about conditioned responses for decades.  The new research underscores the brain chemistry behind this kind of conditioning, illustrating why old habits can be so hard to break.  It also found that some people were more easily distracted by prior rewards than others, and the researchers believe that people who are prone to addiction are among the ones most easily distracted.  Their hope is that there may be pharmaceutical ways to disrupt the neurochemical responses which cause the distractions.

These findings are very pertinent in a time when we increasingly understand the connection between lifestyle choices and diseases, especially (but not exclusively) chronic diseases.  Lifestyle diseases include such common diseases as heart disease, obesity, and type 2 diabetes.  Dr. David Boyd of Cancer Treatment Centers of America says half of cancers can be avoided through lifestyle changes as well.  Changing bad health habits is clearly essential to improving our health and to helping to combat rising health costs.

"Population health management" is seen as a key tool towards this.  It uses data to identify at-risk individuals and coach them to behaviors that might help them prevent or defer their getting lifestyle-related diseases, or at least help them manage the risks of ones they already have.

Population health management is hot, predicted to grow at a 23% CAGR between 2015 and 2020, reaching some $31b.  For that much new spending, there better be a lot of offsetting savings, but realizing those savings may not be so easy.  A new survey by Numerof & Associates found that virtually all health care organizations surveyed said population health management was important to their future success -- 54% said it was critical -- but two-thirds thought their capabilities were only average, or worse.

That doesn't bode well.

It's just hard to change bad health habits.  For example, many employee wellness programs use financial incentives or penalties.  Despite employers getting increasingly tough about workers (and their families) participating in them, the $8b spent on them annually has not shown much provable ROI (unless they are targeted specifically to the people already shown to be high cost).

A new study in Health Affairs found that financial incentives in such programs were not effective in promoting weight loss.  The authors concluded that the financial incentive was not what motivated people, and that how the incentives are designed -- such as more periodic feedback -- is critical.

In other words, people's brains were lighting up at the memory of that donut, but not so much about those potential future financial rewards.

Many people believe that digital health solutions may be the not-so-secret weapon in helping people improve their bad habits.  Chloe Schneider writes in Mashable  about how mobile apps and devices can serve as "blind spot detection tools for your life," helping people combat habits they are trying to break or helping instill desired new habits into their lives.

I especially liked Ms. Schneider's quote: "To break a habit, you have to make a habit," which is very similar to what one of the authors of the Johns Hopkin's study told CNN: "Often the most effective way to unlearn a habit is to replace it with a new one."  

Yusuf Sherwani recently recapped the importance of using mobile health tools to tackle chronic conditions, but stresses that "it's all about health behavior."  He urges that digital health must do a better job of getting clinical validations for its interventions, and create "...highly structured and personalized evidence-based behavioral therapies to tackle specific risky health behaviors."

As he pointed out, not all smokers smoke for the same reasons, nor have the same motivations for wanting to quit, so a smoking cessation program that doesn't recognize these differences is doomed to fail for most people.

It's the same reason that over half of people who buy health trackers stop using them within six months.

Maybe the answer to this will be better living through more prescription drugs.  The Johns Hopkins study speculated about using them to block neurochemical triggers for people prone to addiction.  Scientists are already hard at work on pills to combat obesity ("poop pills"?) or even to mimic the effects of exercise.  I'm sure there are numerous other examples of trying to use a pharmaceutical approach to behavior modification.

We've been trying to manage our lifestyle diseases through an ever-growing number of prescription drugs (spending more on them all the time), so it shouldn't come as a surprise that we might conclude that pharmaceutical approaches might also help us break bad habits that have led/could lead to the diseases

To me, that would be like winning the battle but losing the war.

Certainly chemical interventions may be appropriate for addictions, as they have been for other mental health disorders.  Perhaps all "bad" health habits are attributable to chemical imbalances.  Still, I like to think our brain can play a bigger role in developing better habits than simply being medicated.

Lots of companies are looking to strike it rich through sophisticated population health management software and snazzy health tracking apps, but the pot of gold will be in solutions that actually get people to replace their bad habits with healthier ones.

OK, now time for my cookie -- er, I meant carrot.