I tried the Bonobos shopping experience, looking to get a lightweight blazer for a planned trip to Malaysia and Thailand this summer. I learned from the Bonobos ninja (a shopping guide) about unconstructed jackets. There was a 100% wool version that seemed rather lightweight and appropriate. There was also a 100% cotton unconstructed jacket on sale, much less costly, in a very similar style. Seeing the cotton jacket’s fabric was clearly of heavier weight than the wool jacket reassured me of the wool jacket’s appropriateness for my trip.

Now logically, the weight of the cotton jacket tells me nothing about how comfortable I am going to feel in that wool jacket. But humans are not built logical. I am knowledgeable. I’ve read original research and books on behavioral economics. I understand framing effects and how they work. Comparing the jackets was a classic example. The characteristics of the wool jacket—whether it will keep me cool or leave me sweating like a Star Wars storm trooper on a desert planet—have absolutely nothing to do with the cotton jacket. I know this. Yet still, emotionally, the lighter weight material in the wool jacket relative to the cotton jacket assured me, even though I knew it shouldn’t, that the wool jacket was what I needed for the trip.

The wool jacket cost $400. If Bonobos wanted to assure that I bought the wool jacket, they could have told me the jacket costs $800 but was on sale for $400. Logically, either way, the price is $400, and I should make the decision of whether to buy it or not simply on the basis of the absolute price, $400. But buying an $800 jacket for $400 feels better than buying a $400 jacket.

The pharmacology textbook I used in medical school didn’t tell me anything about this, even though framing is a powerful tool for getting patients to take their medication and getting patients to take their medication is probably the single most important thing to know about pharmacology.

Consider this very simple example. We have some new drugs that are given by injection, perhaps as little as once a month. But patients who have never been on an injection are reluctant to start taking shots.  It’s a scary step. But let’s see how it sounds when we reframe it: “You’ll have to take the medication by injection once a day. Once a day? Did I say once a day? I must be having a senior moment. You only have to take the injection once a month!”

You learned in Marketing 101 how to frame prices. We can apply the same tools to improve adherence.

  • Steven Feldman, M.D.

    Dr. Steven Feldman is Professor of Dermatology and Public Health Sciences at Wake Forest Baptist Medical Center. Steve studies patient adherence at North Carolina’s Wake Forest Baptist Medical Center. He is also Chief Science Officer of Causa Reseach, an adherence solutions company (www.causaresearch.com), founder of www.DrScore.com, and author of “Compartments” and “An Illustrated Dictionary of Behavioral Economics for Healthcare Professionals.”


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