Behavioural economics and pharmacy

Trevor Gore explains how pharmacists can leverage behavioral economics to guide patients toward healthier choices...

At this year’s pharmacy show and many recent conferences, I have given presentations on behavioural economics. People’s health outcomes are greatly determined by behaviours outside the pharmacy or other health settings. Whether they take their medicines, give up smoking or eat healthily, these choices are made at home in the course of their daily lives.

How many minutes of the 168 hours in a week, are your customers in contact with you? For many pharmacists, behavioural economics is a ‘new’ discipline and often flies in the face of what we learned at university years ago. People had symptoms, often traced back to a disease, which led to a treatment, which the patient took (as instructed) and got better. If only! In the context of healthcare, behavioural economics shows that people do not always make decisions based purely on rational cost-benefit analysis. Instead, our choices are often shaped by factors like cognitive biases, social influence, and environmental cues. Once you’ve left university and started practicing in the real world, this should not come as a surprise. The fact is people do not always act in their own best interest and people do not always do the “right” thing, even if they know what the right thing is.

Intention can be a poor predictor of actual health behaviour change—now termed the intention-behaviour gap. In other words, although patients intend to change and maintain their behaviour, the data suggest that many will not follow through with their intention.

The good news is that whilst people may be irrational, they are irrational in highly predictable ways, and we can, and should, design solutions that account for this.

There are well over 100 cognitive biases. In the context of behavioural economics, cognitive bias refers to systematic patterns of deviation from rationality in judgment and decision-making. These biases occur because the brain relies on mental shortcuts (heuristics) to make decisions more efficiently, but these shortcuts can lead to irrational or flawed outcomes. Cognitive biases influence how people perceive, interpret, and respond to information, often leading them to make decisions that deviate from the optimal or economically rational choice.

Some of my favourite examples of cognitive biases include:

1. Anchoring bias: The tendency to rely too heavily on the first piece of information encountered (the "anchor") when making decisions, even if it is irrelevant to the situation. A pharmacist might form an initial impression of a patient based on their first few interactions (e.g., assuming a patient is non-compliant with their medications because they missed a dose). This initial "anchor" may lead the pharmacist to dismiss later concerns or symptoms without fully investigating the root causes.
2. Loss aversion: The tendency for people to prefer avoiding losses over acquiring equivalent gains, often leading to risk-averse behaviour and suboptimal decision-making. When advising a customer on smoking cessation, the statement “You will gain 5 years of life by quitting smoking” is 2-3 times less impactful than “ You will lose  5 years of life by continuing smoking”
3. Confirmation bias: The tendency to search for, interpret, and remember information that confirms one’s preexisting beliefs, while disregarding contradictory evidence. If a pharmacist believes strongly in a certain treatment protocol (such as recommending a specific over-the-counter medication for a common cold), they might ignore emerging evidence or guidelines that suggest alternatives or more effective approaches.
4. Framing effects: How a choice is framed can influence decisions. Which would you rather buy, a drink that claims to be 20% fat, or its competitor which claims to be 80% fat free? The vast majority of people would choose the fat-free choice. One of my irritations is the continuing ‘framing’ around the Pharmacy First scheme. It's for common ailments NOT minor ones!
5. The paradox of choice: Have you ever tuned into Netflix, and after looking at the richness of its content (there are over 7700 films on Netflix UK) declared “There is nothing to see”? Well congratulations and welcome to the Paradox of Choice or Choice Overload. The prevailing wisdom is that giving consumers more choices makes it easier to choose. In reality, it is the opposite. This is often the situation we put our customers in. Just look at the selection of toothpastes in your local supermarket. 100’s that whiten, prevent tartar, help gums, do all of these , etc. and I know what the consumer does. They choose the one they bought last time, or the one on offer. Nobody has the time, or inclination to read all the information presented to them. How many different pain killers are on your display?

By understanding and applying these and other principles, we can design environments and interventions that help guide people toward making better, healthier choices without limiting their autonomy. It is about changing the context in a way that steers people in the right direction while still preserving choice.

Authored by Trevor Gore, treasurer and trustee of the Self-Care Forum.