Loss aversion: How can it affect family health care decisions?

Loss aversion is a very important psychological principle that people care much more about avoiding losses than they care about making gains. In fact, losing $100 makes people about twice as sad as winning $100 makes them happy. This fundamental human feeling is very important in how stores price items and how successful politicians gain votes. For example, Donald Trump is always telling voters that they will lose jobs, power, money, and safety if they do not vote for him. This makes people more likely to vote for him than someone who talks about plans to improve their lives.

How does this relate to medicine? Unfortunately, very strongly. In elderly people, there are drugs that can make bones much stronger and in almost all people prevent the kind of hip fractures that will lead to early disability or even death. It is also known that about one in 50,000 of people who take the osteoporosis preventative drugs will have bizarre and quite serious atypical fractures.  Scientists estimate that in 50,000 people who take the bone strengthening medications about 1,000 will prevent severe sometimes life ending hip fractures, however, one will have an odd, but serious fracture.  In general, people who are fully informed will not take the medications because the small chance of loss has created a much stronger emotion than preventing a future problem.

This applies to pediatrics because one of the most important functions of a child doctor is to prevent disease, not just treat it. This loss aversion feeling that we all have can lead to bad decisions on the part of some parents.  I can think of two cases in pediatrics: immunizations and safe sleep.

Immunizations prevent diseases and when vaccines were first introduced, there were many cases of polio or measles around so people could see how important it was to prevent them. Now almost no one sees the diseases because the vaccines have been very successful. There are two main reasons parents avoid vaccination: they often hate "shots" and believe internet rumors that immunizations can harm.

As I said recently on NPR, "MMR does not cause autism. Period." But the thought that you may harm your baby is so strong (even though it's not true) some parents will skip immunization to prevent this perceived possible loss.

About six out of every 1,000 US newborns die in the first year of life. Three-fourths of those die from severe prematurity, birth defects, and other problems of the birth process.  About 3,500 die from a group of ailments and accidents called Sudden Unexplained Infant Death (SUID).  Doctors have successfully minimized this by suggesting that babies sleep on their backs and that infants not sleep in the same bed as their parents. But some parents feel so strongly that they could lose their babies if they did not hold them at night that 800 babies in the US die each year from being overlaid and smothered to death.

As you can see, the fear of loss has informed choices that could lead to devastating consequences. Emotionally, we all hate loss, but we have to think logically and promote gain in our children and ourselves.

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