BEHAVIORAL ECONOMICS

Sheena Iyengar is a Professor of Business at Columbia University and has RP which left her with only light perception by the time she was in high school. Her odyssey toward attaining an undergraduate degree from the Wharton School of Business and a doctorate in social psychology from Stanford is detailed in her new book, The Art of Choosing. As this remarkable book shows, she perceives much more than light.

Daniel Kahneman and Amos Tversky pioneered in a field known as behavioral economics, putting some science behind the art of how we make choices, and Sheena builds beautifully on their principles. As practitioners of behavioral optometry, behavioral economics should inform us. One particular area that Sheena illuminates is "manipulation by presentation". The Joint Organizational Policy Statement of the American Academy of Pediatrics and the American Academy of Pediatric Ophthalmology and Strabismus (AAP/AAPOS) is a wonderful illustration of of attempt to manipulate public opinion through selective presentation. Sheena writes:

"Clearly, the way we frame information for ourselves or for others can make a big difference in how we see and respond to choice. Every time we encounter new information or reexamine old information, we're influenced by its presentation. We can use framing to our advantage, but sometimes it has a negative impact on the quality of our decisions."

Judith Warner bought into this framing bias from the AAP/AAPOS in her recent book "We've Got Issues". Dr. Stan Appelbaum did a marvelous job in re-framing her frame such that the NY Times Magazine article toned down her framing bias to a significant extent. It fascinated me to discuss this article with colleagues, as some read it as positive; some read it negative; others were unsure. Those feeling it was negative were concerned enough to wonder whether COVD or the AOA should write a letter to the editor of the NY Times citing how biased Ms. Warner was, verging on yellow journalism.

The NY Times was inundated with readers' comments at the end of the magazine article, to the point of having to close it to new comments:

http://community.nytimes.com/comments/www.nytimes.com/2010/03/14/magazine/14vision-t.html?sort=oldest&offset=10

The same spread of opinion held as I sampled colleagues about their reaction to the readers' comments. Some felt the comments to be generally supportive; some were incensed by the negative comments; others were undecided. Given the luxury of opportunity that this month of pre-planned "time-off" affords me, I went through the comments assigning either a (P) if they were positive; an (N) for negative; and (?) for neutral or off-topic. One reply was removed by the site because of it's abusive nature. I was pleasantly surprised by the tally:

FINAL TALLY: 135 (P) 69 (N) 43 (?)

It is delicious to bask in the glow of pros, the positive comments. They vindicate our position, and they support the role of anecdotalism in any clinical endeavor that deals with human behavior. I,myself, put up comments referencing much supportive evidence that we have through the AOA Clinical Practice Guidelines and other sources. COVD and OEP are marvelous sources, and NORA and CSO have made very impressive strides.

But what, if anything, are we to make of the cons? How uncomfortable would it be address the issues that make some of our colleagues uncomfortable with behavioral optometry? Indeed, would it be uncomfortable to ask if there are those among us who prescribe vision therapy for everyone they examine. Who Rx VT with the end point being interminable. Who Rx lenses for everyone who walks in the door. Where do these perceptions come from?

I leave you with this final thought Sheena Iyengar's dazzling book (p. 126):

"We do the same things in our lives, embracing the information that supports what we already prefer or vindicates choices we previously made. After all, it feels better to justify our opinions rather than challenge them, to contemplate only the pros and relegate the cons to the back of our minds. However, if we want to make the most of choice, we have to be willing to make ourselves uncomfortable."