Why it's so hard to make healthy decisions | David Asch

翻译人员: Jessie Zhang 校对人员: Jiasi Hao

It's April of 2007,

那是 2007 年的 4 月，

and Jon Corzine, the Governor of New Jersey,

新泽西州的州长， 荣·科赞（Jon Corzine），

is in this horrific car accident.

陷入了一场可怕的车祸。

He's in the right front passenger seat of this SUV

当他乘坐的那辆 SUV 在花园州高速公路撞毁的时候，

when it crashes on the Garden State Parkway.

他正坐在副驾驶的座位上。

He's transported to a New Jersey trauma center

他被转移到一家新泽西的 创伤治疗中心，

with multiple broken bones and multiple lacerations.

身上伴有多处骨折和撕裂。

He needs immediate surgery, seven units of blood,

他需要立即接受手术、 7 品脱的输血、

a mechanical ventilator to help him breathe

一个帮助他呼吸的呼吸机，

and several more operations along the way.

以及即将面临的又几场手术。

It's amazing he survived.

他能活下来真的令人震惊。

But perhaps even more amazing,

但可能更令人震惊的是，

he was not wearing a seat belt.

他当时在车里根本没系安全带。

And, in fact, he never wore a seat belt,

事实上，他之前从来不系安全带，

and the New Jersey state troopers who used to drive Governor Corzine around

曾经开车载过科赞州长的 新泽西州巡逻队员

used to beg him to wear a seat belt,

曾求着他系上安全带，

but he didn't do it.

但是他从来没系过。

其实，在科赞当上 新泽西州州长之前，

Now, before Corzine was Governor of New Jersey,

he was the US Senator from New Jersey,

曾是新泽西州的联邦参议员，

再之前，是高盛投资公司的 CEO ，

and before that, he was the CEO of Goldman Sachs,

responsible for taking Goldman Sachs public,

负责高盛的上市，

making hundreds of millions of dollars.

并为其赚取了上亿美元。

Now, no matter what you think of Jon Corzine politically

不论你从政治上 还是挣钱方式上

or how he made his money,

是如何看待荣·科赞这个人的，

nobody would say that he was stupid.

没人会说他是个蠢人。

But there he was,

但是你瞧他，

an unrestrained passenger in a car accident,

在每一个美国人都知道 安全带能救命的时候，

at a time when every American knows that seat belts save lives.

他就是那个车祸现场中 不系安全带的人。

This single story reflects a fundamental weakness

这个简单的故事反映出

我们在改善健康行为的方法中 的一个基本的弱点。

in our approach to improving health behavior.

Nearly everything we tell doctors and everything we tell patients

我们告诉医生和病人的 一切东西几乎

is based on the idea that we behave rationally.

都是基于“人类行为是理性的”观点。

If you give me information, I will process that information in my head,

如果你给我信息， 我会在脑袋里分析那个信息，

and my behavior will change as a result.

然后我的行为会随之改变。

Do you think Jon Corzine didn't know that seat belts save lives?

你觉得荣·科赞 不知道安全带能救命吗？

你觉得他只是没收到提示便笺吗？

Do you think he, like, just didn't get the memo?

(Laughter)

（笑声）

Jon Corzine did not have a knowledge deficit,

荣·科赞没有知识缺失，

he had a behavior deficit.

他有的是行为上的缺失。

It's not that he didn't know better.

他不是知道的少，

He knew better.

他知道的并不少。

It's that he didn't do better.

而他，没能做好。

Instead, I think the mind is a high-resistance pathway.

另外，我认为人的思想 是个抵御性很强的东西。

Changing someone's mind with information is hard enough.

用信息改变一个人的思想 已经够难的了，

用信息改变他们的行为

Changing their behavior with information

is harder still.

更是难上加难。

The only way we're going to make substantial improvements

我们能在健康和医疗保健方面

in health and health care

做出较大改善的唯一方法，

is to make substantial improvements in the behavior of health and health care.

就是尽可能改善人们 在健康和医疗保健方面的行为方式。

If you hit my patellar tendon with a reflex hammer,

如果你用一个反射锤 敲击我的膑腱，

my leg is going to jerk forward,

我的腿会向前弹起，

and it's going to jerk forward a lot faster and a lot more predictably

而且会比我自己 想着让它弹起的时候

than if I had to think about it myself.

弹得更快，更具可预测性。

这是一种反射行为。

It's a reflex.

We need to look for the equivalent behavioral reflexes

我们得找到相似的反射行为，

and hitch our health care wagon to those.

并把我们的医疗保健 都靠到这些反射行为上来。

Turns out, though,

但实际上，

最常规的激励人们的举措

that most conventional approaches to human motivation

are based on the idea of education.

却是建立在“教育”这一理念上的。

We assume that if people don't behave as they should,

我们假定如果人们 没有做出他们应有的行为

it's because they didn't know any better.

是因为他们缺乏知识。

“如果人们知道抽烟很危险， 他们就不会抽烟了。”

"If only people knew that smoking was dangerous, they wouldn't smoke."

Or, we think about economics.

或者，我们会从经济的角度思考。

The assumption there is that we're all constantly calculating

我们假定自己会不断地计算

the costs and benefits of every one of our actions

我们每一个行为蕴含的 成本和收益，

and optimizing that to make the perfectly right, rational decision.

以及为了收益最大化， 我们会做出完全正确且理性的决定。

If that were true, then all we need to do

如果这是真的，所有我们需要的

is to find the perfect payment system for doctors

仅仅是给医生找到 一个完美的付费系统，

or the perfect co-payments and deductibles for patients,

或是能给患者完美计算出 部分承担费用和免赔额，

and everything would work out.

然后一切就自然解决了。

A better approach lies in behavioral economics.

行为经济学中 有一个更好的方法。

Behavioral economists recognize that we are irrational.

行为经济学家意识到 我们其实是非理性的。

Our decisions are based on emotion,

我们的决定是建立在情绪上的，

or they're sensitive to framing or to social context.

或是被社会环境 或规则框架所影响的。

We don't always do what's in our own long-term best interests.

我们不总是会做出 有利于我们长远利益的行为。

But the key contribution to behavioral economics

但是，对行为经济学最主要的贡献

is not in recognizing that we are irrational;

不是对“人类是非理性的”认识，

而是意识到 “人类的非理性行为是高度可预测的”。

it's recognizing that we are irrational in highly predictable ways.

In fact, it's the predictability of our psychological foibles

事实上，正是我们心理上 那些小缺陷的可预测性

使我们能设计出策略来攻克它们。

that allows us to design strategies to overcome them.

Forewarned is forearmed.

预先警告就宛如事先武装。

In fact, behavioral economists often use

事实上，行为经济学家 经常精准利用

precisely the same behavioral reflexes that get us into trouble

那些让我们陷入麻烦的 行为反射，

and turn them around to help us,

转而让它们来帮助我们，

而不是伤害我们。

rather than to hurt us.

We see irrationality play out in something called "present bias,"

我们可以在一种叫做“即时偏误”的 现象中看见非理性的作用，

where the outcomes in front of us are much more motivating

这种现象，是我们正在面对的结果

than even more important outcomes far in the future.

比将来会出现的更重要的结果 更能调动我们的积极性。

If I'm on a diet -- and I'm always on a diet --

如果我在节食—— 其实我一直在节食——

(Laughter)

（笑声）

and someone offers me a luscious-looking piece of chocolate cake,

这时有人给了我一个 看上去很美味的巧克力蛋糕，

I know I should not eat that chocolate cake.

我知道我不应该吃那个蛋糕。

That chocolate cake will land on that part of my body -- permanently --

那块巧克力蛋糕会沉积在 我身体中——永远——

where that kind of food naturally settles.

就在这类食物会自然沉积 的身体部位上。

But the chocolate cake looks so good and delicious,

但是那块巧克力蛋糕 看起来如此美味，

而且它就在我的眼前，

and it's right in front of me,

and the diet can wait 'til tomorrow.

那节食可以明天再说了。

I used to love the comedian Steven Wright.

我曾经很喜欢一个喜剧演员， 史蒂文·赖特。

He would have these Zen-like quips.

他经常说些很有禅意的玩笑话。

My favorite one was this:

我最喜欢的是这个：

"Hard work pays off in the future,

“努力了将来会有回报，

but laziness pays off right now."

但是懒惰了现在就会有回报。”

(Laughter)

（笑声）

And patients also have present bias.

患者也有即时偏误。

If you have high blood pressure,

如果你有高血压，

even if you would desperately like to avoid a stroke,

即使你极度想避免中风，

and you know that taking your antihypertensive medications

而且你知道吃降血压药

is one of the best ways to reduce that risk,

是降低这种风险最有效的方式之一，

the stroke you avoid is far in the future and taking medications is right now.

然而，中风是很久以后可能发生的事， 而吃药则是现在要做的。

Almost half of the patients who are prescribed high blood pressure pills

几乎有一半开了降血压药的患者

stop taking them within a year.

在一年内就停止了服药。

想想如果我们单单解决这一个问题

Think of how many lives we could save

就能拯救多少生命。

if we could solve just that one problem.

We also tend to overestimate the value of small probabilities.

我们也容易高估小概率事件的价值。

This actually explains why state lotteries are so popular,

这也许能解释为什么国营彩票 即使回报极小，

even though they return pennies on the dollar.

却依旧这么受欢迎。

Now, some of you may buy lottery tickets --

在座的一些人可能会买彩票——

it's fun, there's the chance you might strike it rich ...

买彩票挺有意思的， 你有可能中大奖、变富有——

But let's face it:

但是咱们清醒一点吧：

this would be a horrible way to invest your retirement savings.

这可能是个花掉你养老金的 很糟糕的方式。

I once saw a bumper sticker -- I am not making this up -- that said,

我曾经看到过一张车尾贴—— 这不是我编的——写着，

"State lotteries are a special tax on people who can't do math."

“国营彩票是向不会 数学计算的人征收的智商税”。

(Laughter)

（笑声）

It's not that we can't do the math,

我们并不是不会做数学计算，

it's that we can't feel the math.

我们是感受不到这种计算。

And we also pay much too much attention to regret.

而且我们花太多精力在后悔上。

We all hate the feeling of missing out.

我们都痛恨错过机会的感觉。

So, actually, there was this recent lottery,

所以，事实上，最近有个彩票，

a mega-jackpot lottery,

大乐透彩票，

that had a huge payoff, something like over a billion dollars.

回报超高，大概超过 10 亿美元。

And everyone in my office is pooling money to buy lottery tickets,

我办公室里的每个人都在 掏钱集资买彩票，

and I'm not having any of this.

我一点都不理解。

There I am, like, swaggering around the office,

我在办公室里转悠，嚷嚷着：

"Lotteries are a special tax on people who can't do math."

“彩票是向不会数学计算的人 征收的智商税。”

(Laughter)

（笑声）

And then it hits me:

然后一个想法击中了我：

uh oh.

啊呀，

What if they win?

万一他们中奖了呢？

(Laughter)

（笑声）

I'm the only one who shows up at work the next day.

我就成了第二天唯一来上班的人了。

（笑声）

(Laughter)

不是我不想让我的同事中奖。

Now, it's not that I didn't want my colleagues to win.

I just didn't want them to win without me.

我只是不想让他们丢下我，自己中奖。

Now, it would have been easier if I had just taken my 20-dollar bill

如果我当初拿出一张 20 美元钞票 直接塞进办公室的碎纸机里，

and put it into the office shredder,

事情本会简单很多，

而且结果也会是一样的。

and the results would have been the same.

即使我知道我不应该参与，

Even though I knew I shouldn't participate,

I handed over my $20 bill,

我还是递出了 20 美元钞票，

之后我再也没见过它。

and I never saw it again.

(Laughter)

（笑声）

We've done a bunch of experiments with patients

我们和患者做过一些实验。

in which we give them these electronic pill bottles

我们给患者们电子药瓶，

so we can tell whether they're taking their medication or not.

以便于知道他们是否在吃药。

And we reward them with a lottery.

我们用彩票奖励他们。

They get prizes.

他们能得到奖品。

But they only get prizes

但他们只有在前一天吃药的情况下

if they had taken their medication the day before.

才能得到奖品。

If not, they get a message that says something like,

如果没吃，他们会收到 一条诸如此类的信息：

"You would have won a hundred dollars,

“你本来能赢 100 美金，

但是你昨天没吃药， 所以你没法得到这笔钱。”

but you didn't take your medicine yesterday, so you don't get it."

Well, it turns out, patients hate that.

事实证明，患者们痛恨那种感觉。

They hate the sense of missing out,

他们痛恨错过的感觉，

and because they can anticipate that feeling of regret

而且因为他们能预判到 那种悔恨的感觉，

and they'd like to avoid it,

于是想要尽量避开它，

they're much more likely to take their medications.

所以他们更有可能会吃药了。

掌控那种痛恨后悔的感觉是有用的。

Harnessing that sense of hating regret works.

And it leads to the more general point,

它引出了更一般化的观点，

which is: once you recognize how people are irrational,

即：一旦你认识到人是非理性的，

you're in a much better position to help them.

你就会处于一个 能够更好地帮助他们的位置。

Now, this kind of irrationality works out even in men's restrooms.

这种非理性 甚至在男厕所也能用得上。

在座的不常光顾小便池的人，

So, for those of you who don't frequent urinals,

let me break this down for you.

让我给你们解析一下。

(Laughter)

（笑声）

There is pee all over the floor.

地板上全是尿。

(Laughter)

（笑声）

And it turns out that you can solve this problem

事实证明，你只要在小便池上 蚀刻一个苍蝇的形象，

by etching the image of a fly in the back of the urinal.

就能解决这个问题。

(Laughter) (Applause)

（笑声） （掌声）

And it makes perfect sense.

这完全说得通。

(Laughter)

（笑声）

If I see a fly,

如果我看见一只苍蝇，

我一定要射中那只苍蝇。

I'm gonna get that fly.

(Laughter)

（笑声）

That fly is going down.

那只苍蝇会被冲入下水道。

(Laughter)

（笑声）

Now, this naturally begs the question that if men can aim,

这自然地引出了一个问题： 如果男人们上厕所时能瞄准，

why were they peeing on the floor in the first place?

他们一开始为什么要尿到地上？

In fact, if they were going to pee on the floor,

实际上，如果他们 本来就打算尿到地上，

又为什么要跑到小便池前面去尿？

why pee in front of the urinal?

你可以在任何地方尿。

You could pee anywhere.

(Laughter)

（笑声）

And the same thing works in health care.

同样的道理也适用于医疗保健。

We had a problem in our hospital

我们医院当时有个这样的问题：

in which the physicians were prescribing brand-name drugs

当普通药可供选择的时，

when a generic drug was available.

医生们却一直在开品牌药。

Each one of the lines on this graph represents a different drug.

这张图上的每条线 代表一种不同的药物。

And they're listed according to how often they're prescribed as generic medications.

这些药根据被当做普通药开 的频率被列了出来。

Those are the top are prescribed as generics 100 percent of the time.

位于顶部的， 是一直都被当做普通药开的。

下面那些， 不到 20% 的机率

Those down at the bottom are prescribed as generics

less than 20 percent of the time.

是被当做普通药开的。

And we'd have meetings with clinicians and all sorts of education sessions,

我们跟临床医师们开过会， 也办过各种教学会议，

and nothing worked --

但是都没用——

all the lines are pretty much horizontal.

所有的这些线，几乎都没变。

Until, someone installed a little piece of software

直到，有个人在电子健康记录表里

安装了一个小软件，

in the electronic health record

that defaulted the prescriptions to generic medications

把处方设置为默认开普通药，

instead of the brand-name drugs.

而非品牌药。

Now, it doesn't take a statistician

现在，不用统计分析员

to see that this problem was solved overnight,

也能看出来， 问题一夜之间就解决了，

and it has stayed solved ever since.

而且之后再没有出现此类问题。

In fact, in the two and a half years since this program started,

事实上， 在这个项目上线的两年半内，

our hospital has saved 32 million dollars.

我们医院 已经省下了 3200 万美元。

Let me say that again: 32 million dollars.

让我再说一遍： 3200 万美元。

And all we did was make it easier

我们所做的，只不过是 把医生们一直以来想做的事

for the doctors to do what they fundamentally wanted to do all along.

变得容易做了而已。

It also works to play into people's notions of loss.

利用人们对损失的概念也有用。

We did this with a contest to help people walk more.

我们办了场比赛 来帮助人们走更多路。

We wanted everyone to walk at least 7,000 steps,

我们想让每个人至少走 7 千步，

and we measured their step count

我们也用他们手机上的计步器

with the accelerometer on their cell phone.

以记录他们行走的步数。

Group A, the control group, just got told whether they had walked

A 组，控制变量组， 仅被告知他们

是否走够 7 千步。

7,000 steps or not.

Group B got a financial incentive.

B 组，有金钱刺激。

We gave them $1.40 for every day they walked 7,000 steps.

每天如果他们走了 7 千步， 我们就奖励他们 1.4 美金。

Group C got the same financial incentive,

C组，有相同的金钱刺激，

but it was framed as a loss rather than a gain:

但这种刺激被包装成损失 而不是收益：

$1.40 a day is 42 dollars a month,

每天 1.4 美金 即 42 美金一个月，

so we gave these participants 42 dollars at the beginning of each month

所以在每个月的头一天 我们给这些参与者 42 美金，

in a virtual account that they could see,

就放在他们能看见的虚拟账户里，

然后如果他们每天没走够 7 千步， 我们就从账户里取走 1.4 美金。

and we took away $1.40 for every day they didn't walk 7,000 steps.

Now, an economist would say that those two financial incentives

一个经济学家可能会说， 这两种金钱刺激的结果

are the same.

是一样的。

For every day you walk 7,000 steps, you're $1.40 richer.

因为每天你走够 7 千步的话， 你都能赚 1.4 美金。

But a behavioral economist would say that they're different,

但是一个行为经济学家会说， 它们的结果是不同的，

because we're much more motivated to avoid a $1.40 loss

因为我们为避免损失 1.4 美金 会比赚取 1.4 美金

than we are motivated to achieve a $1.40 gain.

来得更有动力。

实验结果也确实如此。

And that's exactly what happened.

Those in the group that received $1.40 for every day they walked 7,000 steps

那些每天因为走 7 千步 而收到 1.4 美金的人

were no more likely to meet their goal than the control group.

并不比控制变量组（没有金钱激励） 更能达到目标。

The financial incentive didn't work.

金钱刺激没能起作用。

而那些受到损失刺激的人

But those who had a loss-framed incentive

met their goal 50 percent more of the time.

则有 50% 更高的可能 完成目标。

It doesn't make economic sense, but it makes psychological sense,

这在经济学上说不通， 但在心理学上是说得通的，

because losses loom larger than gains.

因为损失比收益带来的刺激更大。

And now we're using loss-framed incentives to help patients walk more,

现在我们已经在用这种损失刺激法 去帮助患者走更多路、

lose weight

减肥，

and take their medications.

以及吃药了。

Money can be a motivator.

钱可以是一个激励因素，

We all know that.

我们都知道这一点。

But it's far more influential when it's paired with psychology.

但当它与心理学配对使用时 更具有影响力。

And money, of course, has its own disadvantages.

当然，金钱有其自身缺点。

我最喜欢的例子， 说的是一个日托项目。

My favorite example of this involves a daycare program.

The greatest sin you can commit in daycare is picking up your kids late.

你能在日托中犯下的最大的罪孽 就是接孩子接晚了。

No one is happy.

没人开心。

Your kids are crying because you don't love them.

你的孩子在哭，因为你不爱他们。

(Laughter)

（笑声）

The teachers are unhappy because they leave work late.

老师不开心，因为他们下班晚了。

And you feel terribly guilty.

你也觉得极其内疚。

This daycare program in Israel decided they wanted to stop this problem,

以色列的这个日托项目 就想解决这个问题，

and they did something that many daycare programs in the US do,

而且他们做的， 是许多美国日托项目也在做的事，

which is they installed a fine for late pickups.

就是给晚接孩子的人设置罚款。

And the fine they chose was 10 shekels,

他们把罚款定为 10 谢克尔（以色列货币单位），

which is about three bucks.

大概相当于 3 美元。

And guess what happened?

猜猜然后发生了什么？

Late pickups increased.

晚接孩子的情况恶化了。

And if you think about it, it makes perfect sense.

如果你仔细想想的话， 这完全说得通。

What a deal!

多合适的买卖啊！

For 10 shekels --

10 谢克尔——

(Laughter)

（笑声）

you can keep my kids all night!

你就能一晚上不用接孩子！

(Laughter)

（笑声）

家长们卯足了内在动机， 准时接孩子，

They took a perfectly strong intrinsic motivation not to be late,

结果日托机构 把这个动机因素变得廉价了。

and they cheapened it.

What's worse, when they realized their mistake

更糟的是， 当日托机构意识到自己的错误，

and they took away the financial incentive,

把迟到罚款的规则撤回时，

the late pickups still stayed at the high level.

晚接孩子的情况丝毫没有改观。

They had already poisoned the social contract.

他们已经毒害了社会契约。

Health care is full of strong intrinsic motivations.

医疗保健充满了强大的内在动机。

We have doctors and patients who already want to do the right thing.

医生和患者本身就想做正确的事。

Financial incentives can help,

金钱刺激也有正面作用。

but we shouldn't expect money in health care

但是我们不能盼着

金钱能在医疗保健中 承担全部的重任。

to do all of the heavy lifting.

相反，对健康行为 最有效的影响因素

Instead, perhaps the most powerful influencers of health behavior

are our social interactions.

可能是我们的社会互动。

Social engagement works in health care,

社会参与在医疗保健中是起作用的，

主要体现在两个方面。

and it works in two directions.

First, we fundamentally care what others think of us.

第一，我们本能地在意 别人对我们的看法。

And so one of the most powerful ways to change our behavior

所以改变我们行为 最有效的方法之一

is to make our activities witnessable to others.

就是让我们的行为能被别人看见。

We behave differently when we're being observed

我们在被观察， 和不在被观察时候的行为表现

than when we're not.

是不同的。

I've been to some restaurants that don't have sinks in the bathrooms.

我去过几个饭店， 它们厕所里没有水槽，

Instead, when you step out, the sink is outside

但当你走出来，水槽在外面，

在饭店的主要位置，

in the main part of the restaurant,

where everyone can see whether you wash your hands or not.

这时候所有人都能看见 你洗没洗手。

我不是很确定，

Now, I don't know for sure,

but I am convinced that handwashing is much greater

但我敢保证在那些特定环境下

洗手的人变多了。

in those particular settings.

We are always on our best behavior when we're being observed.

我们在被观察的时候， 总能表现出最好的行为。

In fact, there was this amazing study

事实上，在佛罗里达一家医院

的重症监护室里， 进行了一项很棒的研究。

that was done in an intensive care unit in a Florida hospital.

The handwashing rates were very low, which is dangerous, of course,

这里的洗手率非常低， 当然，这很危险，

because it can spread infection.

因为该行为 会传播疾病，导致感染。

And so some researchers pasted a picture of someone's eyes over the sink.

所以一些研究员在水槽上 贴了一张人眼的照片。

It wasn't a real person, it was just a photograph.

那不是一个真人，只是一张照片。

In fact, it wasn't even their whole face, it was just their eyes looking at you.

实际上，那甚至都不是一整张脸， 只是一双眼睛看着你。

（笑声）

(Laughter)

Handwashing rates more than doubled.

洗手率翻了不止一倍。

我们似乎是如此在意 别人对我们的看法，

It seems we care so much what other people think of us

that our behavior improves

以至于我们的行为会就此改进，

even if we merely imagine that we're being observed.

即使我们仅仅只是 想象我们在被别人观察着。

And not only do we care what others think of us,

而且我们不只是在意 别人怎么看我们，

we fundamentally model our behaviors on what we see other people do.

我们还会本能地模仿他人行为。

And it all comes back to seat belts.

这一切又回到安全带上来了。

When I was a kid, I used to love the "Batman" TV series with Adam West.

我小的时候，喜欢看亚当·韦斯特 演的电视剧《蝙蝠侠》。

Everything that Batman and Robin did was so cool,

蝙蝠侠和罗宾做的所有事都特酷，

and, of course, the Batmobile was the coolest thing of all.

当然了，蝙蝠车是所有事情里最酷的。

Now, that show aired from 1966 to 1968,

那个电视剧从 1966 年播到 1968 年，

and at that time, seat belts were optional accessories in cars.

在那个年代，安全带 还是车里可有可无的配件。

But the producers of that show did something really important.

但是那个电视剧的出品人 做了一件非常重要的事。

When Batman and Robin got in the Batmobile,

当蝙蝠侠和罗宾坐上那辆蝙蝠车时，

the camera would focus on their laps,

相机会聚焦到他们腿上，

and you would see Batman and Robin put on their seat belts.

然后你会看到蝙蝠侠和罗宾 系上了他们的安全带。

Now, if Batman and Robin put on their seat belts,

如果蝙蝠侠和罗宾 系上了安全带，

you can bet that I was going to wear my seat belt, too.

你可以打赌 我也会系上我的安全带。

I bet that show saved thousands of lives.

我打赌那个电视剧 拯救了上千条生命。

And again, it works in health care, too.

再次，这在医疗保健中也能起作用。

Doctors use antibiotics more appropriately when they see how other doctors use them.

在看见别的医生如何使用抗生素后， 医生自己能更加适当地使用抗生素。

So many activities in health care are hidden, they're unwitnessed,

医疗保健中的许多行动 是隐匿的，别人看不见。

但医生是社会动物，

but doctors are social animals,

and they perform better when they see what other doctors do.

因此当他们能看见其他医生的做法时， 他们自己也能表现得更好。

So social influence works in health care.

所以社会影响在医疗保健中 是有积极作用的，

So does tying it to notions of regret or to loss aversion.

把它与后悔感和损失规避 联系起来也是大有裨益的。

We would never think of using these tools if we thought that everyone was rational

如果我们认为每个人 时刻都是理性的，

那我们永远不会想到 利用这些工具。

all the time.

Now, just to be clear: I am not condemning rationality.

这里我要澄清一点： 我不是在指责理性。

I mean, that really would be irrational.

这才会是真正的不理性。

But we all know that it's the nonrational parts of our minds

但我们都知道， 正是我们思想中那些不理性的部分

where we get courage, creativity, inspiration

给予我们勇气、创造力、灵感，

and everything else that sparks passion.

以及其他一切能激发激情的东西。

And we know something else, too.

我们还知道一些别的。

We know that we can be much more effective at improving health behavior

我们知道如果我们能 与天性中不理性的部分合作，

if we work with the irrational parts of our nature

而不是忽视、或跟它们反着来，

instead of ignoring them or fighting against them.

我们就能更有效地改善 我们的健康行为。

When it comes to health care,

当谈到医疗保健时，

understanding our irrationality is just another tool in our toolbox.

理解我们的非理性 只是工具箱中的一个工具。

而掌控这种非理性——

And harnessing that irrationality --

that may be the most rational move of all.

或许才是所有行为中最理性的。

Thank you.

谢谢。

(Applause)

（掌声）