"I realized he had no way the calibrate the benefits of his medications," Roizen said. "In his terms, he could not assess the 'net present value' of drugs designed not to cure current disease but to prevent it in the distant future. So we did some quick calculations and decided that taking his medicines made him the equivalent of four years younger. Ever since, he has taken them religiously."
In exchange, the banker steered Roizen to the work of Chicago economist Milton Friedman, who won the 1976 Nobel Prize, in part for his research on how investors discount future gains. Friedman found that without a straightforward way to calculate the worth of benefits that would not be received for years, investors tended to undervalue them. Benefits that were more than three years away were often seen as worthless.
So Roizen began to adapt the economist's ideas to health care. He put together a scientific advisory team to comb through the massive literature concerning the relationships between various behaviors and longevity. They asked not just whether specific acts, like aerobic exercise, strength training, wearing a helmet to ride a bicycle or flossing your teeth, could reduce rates of mortality, but by exactly how much?
They came up with 125 behaviors that seemed to play a role, each supported by at least four major studies in humans. Then they developed software to calculate the risks and benefits and how they all fit together.
It turned out to be a wonderful motivational tool, far more effective than doctors' orders, warnings, exhortations, admonishments. Roizen soon found himself celebrating "unbirthdays" with his patients as they got healthier, making their RealAge younger, and leading far more vigorous lives.
"With numerical targets, many of them became quite competitive about
it," he said, "choosing, and more important, sticking with behaviors that
made their RealAge younger. We had struck motivational gold."
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Contact: John Easton
jeaston@mcis.bsd.uchicago.edu
773-702-6241
University of Chicago Medical Center
9-Mar-1999