Medicine, Health Care and Philosophy

, Volume 17, Issue 4, pp 641–650 | Cite as

Scientific second-order ’nudging’ or lobbying by interest groups: the battle over Abdominal Aortic Aneurysm Screening Programmes

Scientific Contribution

Abstract

The idea that it is acceptable to ‘nudge’ people to opt for the ‘healthy choice’ is gaining currency in health care policy circles. This article investigates whether researchers evaluating Abdominal Aortic Aneurysm Screening Programmes (AAASP) attempt to influence decision makers in ways that are similar to popular ‘nudging’ techniques. Comparing two papers on the health economics of AAASP both published in the BMJ within the last 3 years, it is shown that the values chosen for the health economics modelling are not representative of the literature and consistently favour the conclusions of the articles. It is argued (1) that this and other features of these articles may be justified within a Libertarian Paternalist framework as ‘nudging’ like ways of influencing decision makers, but also (2) that these ways of influencing decision makers raise significant ethical issues in the context of democratic decision making.

Keywords

Nudging Abdominal aorta aneurysm screening Libertarian paternalism Deliberative democracy Conflict of interest disclosure 

References

  1. Barton, M.B., S. Moore, S. Polk, et al. 2001. Increased patient concern after false-positive mammograms: Clinician documentation and subsequent ambulatory visits. Journal of General Internal Medicine 16(3): 150–156.CrossRefGoogle Scholar
  2. Blumenthal-Barby, J.S., and H. Burroughs. 2012. Seeking better health care outcomes: The ethics of using the “nudge”. The American Journal of Bioethics 12(2): 1–10.CrossRefGoogle Scholar
  3. Brown, L.C., and J.T. Powell. 1999. Risk factors for aneurysm rupture in patients kept under ultrasound surveillance. UK Small Aneurysm Trial Participants. Annals of Surgery 230(3): 289–296.CrossRefGoogle Scholar
  4. Brown, P.M., D.T. Zelt, and B. Sobolev. 2003. The risk of rupture in untreated aneurysms: The impact of size, gender, and expansion rate. Journal of Vascular Surgery 37(2): 280–284.CrossRefGoogle Scholar
  5. Cohen, J. 1998. Democracy and liberty. In Deliberative democracy, ed. J. Elster, 185–231. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
  6. Cohen, J. 2003. Deliberation and democratic legitimacy. In Debates in contemporary political philosophy—An anthology, ed. D. Matravers, and J. Pike, 342–360. London: Routledge.Google Scholar
  7. Darwood, R., J.J. Earnshaw, G. Turton, et al. 2012. Twenty-year review of abdominal aortic aneurysm screening in men in the county of Gloucestershire, United Kingdom. Journal of Vascular Surgery 56(1): 8–13.CrossRefGoogle Scholar
  8. Dinnner, I., E.J. Johnson, D.G. Goldstein, et al. 2010. Partitioning default effects: Why people choose not to choose. Journal of Experimental Psychology: Applied 17(4): 332–341.Google Scholar
  9. Ehlers, L., K. Overvad, J. Sorensen, et al. 2009. Analysis of cost effectiveness of screening Danish men aged 65 for abdominal aortic aneurysm. British Medical Journal 338: b2243.CrossRefGoogle Scholar
  10. Fearon, J.D. 1998. Deliberation as discussion. In Deliberative democracy, ed. J. Elster, 44–68. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
  11. Feinberg, J. 1986. Harm to self—The moral limits of the criminal law. New York: Oxford University Press.Google Scholar
  12. Grondal, N., R. Sogaard, E.W. Henneberg, et al. 2010. The Viborg vascular (VIVA) screening trial of 65–74 year old men in the central region of Denmark: Study protocol. Trials 11: 67.CrossRefGoogle Scholar
  13. Habermas, J. 1976. Legitimation crisis. London: Heinemann.Google Scholar
  14. Hansson, A., J. Brodersen, S. Reventlow, et al. 2012. Opening Pandora’s box: The experiences of having an asymptomatic aortic aneurysm under surveillance. Health, Risk & Society 14(4): 341–359.CrossRefGoogle Scholar
  15. Henriksson, M., and F. Lundgren. 2005. Decision-analytical model with lifetime estimation of costs and health outcomes for one-time screening for abdominal aortic aneurysm in 65-year-old men. British Journal of Surgery 92(8): 976–983.CrossRefGoogle Scholar
  16. Holm, S., and T. Ploug. 2013. “Nudging” and informed consent revisited: Why “nudging” fails in the clinical context. American Journal of Bioethics 13(6): 29–31.CrossRefGoogle Scholar
  17. Lafata, J.E., J. Simpkins, L. Lamerato, et al. 2004. The economic impact of false-positive cancer screens. Cancer Epidemiology Biomarkers & Prevention 13(12): 2126–2132.Google Scholar
  18. Lederle, F.A. 2009. The natural history of abdominal aortic aneurysm. Acta Chirurgica Belgica 109(1): 7–12.Google Scholar
  19. Lederle, F.A., G.R. Johnson, S.E. Wilson, et al. 2002. Rupture rate of large abdominal aortic aneurysms in patients refusing or unfit for elective repair. JAMA 287(22): 2968–2972.CrossRefGoogle Scholar
  20. Lindholt, J.S., and J. Sorensen. 2010. Hospital costs for abdominal aortic aneurysm surgery. Ugeskrift for Laeger 172(33): 2206–2212.Google Scholar
  21. Lindholt, J.S., S. Juul, H. Fasting, et al. 2005. Screening for abdominal aortic aneurysms: Single centre randomised controlled trial. British Medical Journal 330(7494): 750.CrossRefGoogle Scholar
  22. Lindholt, J.S., J. Sorensen, R. Sogaard, et al. 2010. Long-term benefit and cost-effectiveness analysis of screening for abdominal aortic aneurysms from a randomized controlled trial. British Journal of Surgery 97(6): 826–834.CrossRefGoogle Scholar
  23. Manin, B. 1987. On legitimacy and political deliberation. Political Theory 15(3): 338–368.CrossRefGoogle Scholar
  24. Mitchell, J.B., and A.J. Moore. 2011. Lifetime individual retirement arrangements: An application of Thaler and Sunstein’s NUDGE. Journal of Accounting and Finance 11(2): 16–25.Google Scholar
  25. Montreuil, B., and J. Brophy. 2008. Screening for abdominal aortic aneurysms in men: A Canadian perspective using Monte Carlo-based estimates. Canadian Journal of Surgery 51(1): 23–34.Google Scholar
  26. Nozick, R. 1969. Coercion. In Philosophy, science, and method: Essays in honor of Ernest Nagel, ed. S. Morgenbesser, P. Suppes, and M. White, 440–472. New York: St. Martin’s Press.Google Scholar
  27. Pedersen LV. 2012. Forskernes retssikkerhed er tvivlsom. Weekendavisen 22. juni 2012.Google Scholar
  28. Ploug, T., S. Holm, and J. Brodersen. 2012. To nudge or not to nudge—Cancer screening programmes and the limits of libertarian paternalism. Journal of Epidemiology and Community Health 66(12): 1193–1196.CrossRefGoogle Scholar
  29. Redelmeier, D.A., P. Rozin, and D. Kahneman. 1993. Understanding patients’ decisions: Cognitive and emotional perspectives. JAMA 270(1): 72–76.CrossRefGoogle Scholar
  30. Rughani, G., L. Robertson, and M. Clarke. 2012. Medical treatment for small abdominal aortic aneurysms. Cochrane Database Systematic Review 9: CD009536.Google Scholar
  31. Saghai, Y. 2013. Salvaging the concept of nudge. Journal of Medical Ethics 00: 1–7. doi:10.1136/medethics-2012-100727.Google Scholar
  32. Schumpeter, J.A. 1942. Capitalism, socialism and democracy. New York: Harper and Brothers.Google Scholar
  33. Silverstein, M.D., S.R. Pitts, E.L. Chaikof, et al. 2005. Abdominal aortic aneurysm (AAA): Cost-effectiveness of screening, surveillance of intermediate-sized AAA, and management of symptomatic AAA. Proceedings (Baylor University. Medical Center) 18(4): 345–367.Google Scholar
  34. Søgaard, R., J. Laustsen, and J.S. Lindholt. 2012. Cost effectiveness of abdominal aortic aneurysm screening and rescreening in men in a modern context: Evaluation of a hypothetical cohort using a decision analytical model. British Medical Journal 345: e4276.Google Scholar
  35. Sunstein, C.R., and R.H. Thaler. 2003. Libertarian paternalism is not an oxymoron. The University of Chicago Law Review 70(4): 1159–1202.CrossRefGoogle Scholar
  36. Svensjo, S., M. Bjorck, M. Gurtelschmid, et al. 2011. Low prevalence of abdominal aortic aneurysm among 65-year-old Swedish men indicates a change in the epidemiology of the disease. Circulation 124(10): 1118–1123.CrossRefGoogle Scholar
  37. Sweeting, M.J., S.G. Thompson, L.C. Brown, and J.T. Powell. 2012. Meta-analysis of individual patient data to examine factors affecting growth and rupture of small abdominal aortic aneurysms. British Journal of Surgery 99: 655–665.CrossRefGoogle Scholar
  38. Takagi, H., H. Yamamoto, K. Iwata, et al. 2012. Effects of statin therapy on abdominal aortic aneurysm growth: A meta-analysis and meta-regression of observational comparative studies. European Journal of Vascular and Endovascular Surgery 44(3): 287–292.CrossRefGoogle Scholar
  39. Thaler, R.H., and C.R. Sunstein. 2008. Nudge—Improving decisions about health, wealth and happiness. London: Penguin Books.Google Scholar
  40. Thompson, S.G., H.A. Ashton, L. Gao, et al. 2009. Screening men for abdominal aortic aneurysm: 10 Year mortality and cost effectiveness results from the randomised Multicentre Aneurysm Screening Study. British Medical Journal 338: b2307. doi:10.1136/bmj.b2307.:b2307.CrossRefGoogle Scholar
  41. Thompson, S.G., H.A. Ashton, L. Gao, Buxton, M. J., Scott, R. A. P., et al. 2004. Final follow-up of the Multicentre Aneurysm Screening Study (MASS) randomized trial of abdominal aortic aneurysm screening. British Journal of Surgery 99:1649–1656.Google Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2014

Authors and Affiliations

  1. 1.Department of Communication and Psychology, Centre for Applied Ethics and Philosophy of ScienceAalborg University CopenhagenCopenhagen SVDenmark
  2. 2.Centre for Social Ethics and Policy, School of LawUniversity of ManchesterManchesterUK
  3. 3.Center for Medical Ethics, Faculty of MedicineUniversity of OsloOsloNorway
  4. 4.Centre for Applied EthicsAalborg UniversityAalborgDenmark
  5. 5.The Research Unit and Section for General Practice, Department of Public Health, Faculty of Health SciencesUniversity of CopenhagenCopenhagenDenmark

Personalised recommendations