The folly of optimism bias

What cripples Americans’ health as much as anything is a misguided tendency known as optimism bias. People tend to believe they are invincible. They expect misfortune to befall others rather than themselves. It is a judgment error, not to be mistaken for an optimistic outlook on life.

Rutgers psychology professor Neil Weinstein stumbled across this when he discovered that his students had unrealistic expectations about their performance on tests. He studied the bias extensively and found it exists in many facets of life, but especially in health.

Most people believe their skills are “above average,” a statistical impossibility like Garrison Keillor’s assertion about the children in mythical Lake Wobegon. They overestimate how swiftly they will accomplish tasks and usually reach optimistic conclusions based on little or no evidence.

A good example of optimism bias was found in a survey of about 1 million high school seniors in the 1970s. About 70 percent believed they had above-average leadership skills, compared with 2 percent who said they were below average. About 60 percent rated themselves in the top 10 percent in ability to get along with others, and 25 percent said they were in the top 1 percent.

Health research is full of optimism bias. Patients guide themselves with half-baked medical theories and misinformation, often with dire consequences for their health and longevity. People tend to predict the future based on experience: If there were no consequences to behavior before, there will be none in the future. They consider themselves somehow exempt from risk.

This self-confidence can be fatal. People with heart-attack symptoms delay seeking medical attention because the signals do not match their notions of what they think a heart attack should feel like. Likewise, a majority of patients with high blood pressure believe they can tell whether it is elevated,   according to one study – even though the condition has no symptoms. People in the blood-pressure “symptom” group acknowledged that most people cannot detect when their blood pressure rises  – but said they themselves could. (This actually made them more compliant patients. This false notion led them to follow doctors’ orders to take medication, watch their diet and exercise to control the mythical symptoms.)

Weinstein surveyed adults with risky lifestyles to see how they rate their chances of acquiring health conditions such as cancer or alcoholism, or encountering other negative events such as auto accidents or getting divorced. The response: Somewhere between average and lower than average. The bias occurred regardless of age, gender, income or education level.

People take this notion of self-control even farther by overrating the effectiveness of their actions. That inflates the self-delusion even more. On the other hand, people are reluctant to take responsibility for poor performance. They tend to blame factors outside their control, such as the difficulty of the task.

Optimism bias is fairly immune to intervention. It is difficult for those who have it to believe otherwise. They rarely alter their behavior even after being shown that their chances of early death and disease are no better than average. The reason: They still believe their own risk is relatively low.

In international studies, Americans show a stronger association of optimism bias and personal control than non-Americans. The sense of control over events and the concept of personal responsibility are deeply embedded in capitalist nations such as the United States. Such notions tend to result in faulty risk estimations, leading to a disconnect between misinformed judgment and reality.

However, optimism bias is not without its merits. The outlook reflects a high level of self-esteem, which itself is beneficial to good health. An attitude of invincibility has a way of reducing anxiety. People who are optimistic about their futures place a higher value on their health because they expect good things ahead. They are better at building social networks, which help protect health, and probably are less likely to have had their health compromised by life’s tragedies.

In personal health, fear is good but pessimism is not

Caution about health hazards leads to doing the right things. A wealth of research shows that the degree to which people feel vulnerable to health problems predicts how likely they are to engage in healthy behavior. Optimism bias leads to ignoring information about what promotes health, and a tendency toward riskier behavior. In short, there is not enough fear.

However, unrealistic pessimism can be as bad as optimism bias. People with fatalistic beliefs, consumed by hopelessness, think nothing they do will alter their destiny.

The onslaught of everything-causes-cancer news contributes to this. Indeed, a national survey of more than 6,000 U.S. adults found that about half agreed with the statement: “It seems like almost everything causes cancer.” Three-fourths agreed that “there are so many recommendations about preventing cancer that it’s hard to know which ones to follow.”

Remarkably, about 1 out of 4 agreed with this: “There’s not much people can do to lower their chances of getting cancer.” Those with the strongest fatalistic beliefs were less likely to eat fruits and vegetables and more likely to continue to smoke.

The patient-doctor disconnect

A 2009 poll of 2,000 Americans by GE Healthcare, the Cleveland Clinic and Ochsner Health System in New Orleans is an elegant example of optimism bias at work. More than half the respondents said other people’s health “was going in the wrong direction,” compared with 17 percent who characterized their own health that way.

Only one-quarter to one-third knew their personal basic health numbers – body-mass index, blood pressure, cholesterol, blood-glucose level – yet the majority said keeping those numbers in a good range was important to health.

About 95 percent said regular physician checkups were important, but 70 percent admitted avoiding their doctors by hoping health problems would go away or asking a friend for medical advice.

Pollsters asked respondents to grade their health behaviors, and asked doctors to do the same. One out of 3 gave themselves an “A” for nutrition, exercise and personal health management. More than 90 percent of the doctors, however, graded patients “C” or worse on these.

Let someone else foot the bill

Another survey reflected Americans’ strong sense of personal control over their health, but also their reluctance to accept financial responsibility for it.

The Vitality Group surveyed more than 1,000 U.S. adults in 2008. About 82 percent said they alone were responsible for their health. However, 44 percent said they should bear no responsibility for paying for their health care, while 56 percent thought they should pick up part of the cost. Six out of 10 thought their employer should be partially responsible, and about one-half believed the government should pick up the tab.

 

The rarity of optimal heart health

According to a new study, people who arrive at middle age without cardiovascular risks nearly make themselves bulletproof for the rest of their lives.

A non-smoking 45-year-old man with normal blood pressure and cholesterol, and no diabetes, has less than a 2 percent chance of having a heart attack or stroke for the rest of his life.

The researchers looked at studies that totaled more than a quarter of a million people. Unfortunately, only 5 percent of the participants had the aforementioned optimal cardiovascular profile.

The study was another piece of evidence of how elusive good health habits are in the U.S.

Four behaviors determine most chronic disease and premature death – cigarette smoking, physical inactivity, excess weight and binge drinking of alcohol. If people made the right decisions about those four, health-care costs would recede as a public-policy ticking time bomb and Americans’ quality of life would soar.

Do not smoke. Eat at least five daily servings of fruits and vegetables. Drink moderately at most. Exercise at least 30 minutes a day. Sounds easy enough. But only 3 percent of Americans do all four.

Those with the American Heart Association ideal cardiovascular profile are even rarer. According to University of Pittsburgh researchers, there are seven factors: body mass index of less than 25; untreated cholesterol under 200; blood pressure below 120/80; fasting blood sugar level below 100; exceeds the government-recommended physical activity guidelines, and follows a heart-healthy diet. Of 1,933 people between the ages of 45 and 75, only one met all seven conditions. Less than 10 percent met five or more of the criteria.

Breaking deadly health habits

According to a just-released study in the journal Cancer, many lung and colorectal cancer patients continue to smoke even after their diagnoses. Nearly 40 percent of lung patients were smokers when they received their diagnosis and 14 percent were still smoking five months later. The similar statistics for colorectal cancer were 14 percent and 9 percent, respectively.

It is easy to shake a judgmental finger at people who continue destructive health habits after chronic-condition diagnoses. However, it underscores that change is difficult even after life-altering chronic conditions.

At least 40 percent of smokers who survive a heart attack continue to smoke a year later. In a group of more than 1,200 overweight heart-attack survivors, the average weight loss was .2 percent. That is less than a one-pound loss for a 220-pound man.

In another study, 884 of 2,500 heart-attack patients had eaten fast food at least once a week one month before the attack. Nearly all receive dietary advice before leaving the hospital. Three months later, 503 were still eating fast food at least once a week.

 

OK, maybe next year

How are those New Year’s resolutions coming along?

Special K, which marked January 2 National Weigh-in Day, surveyed women on weight management. An astounding two-thirds of women started or renewed a weight management plan on January 1. About half also do so for a special event, and that rises to 57 percent in the spring apparently to get “bathing-suit ready.”

Unfortunately, polls show that about 25 percent have abandoned their resolutions by now, and only 10 percent will be sticking with the resolutions a year from now. Gyms and many self-help entrepreneurs build their business models on recycled resolutions.