The Irrational Bundle. Dan Ariely

delayed gratification and self-control. On every injection day I was faced with a trade-off between giving myself an injection and feeling sick for the next 16 hours (a negative immediate effect), and the hope that the treatment would cure me in the long term (a positive long-term effect). At the end of the six-month trial the doctors told me that I was the only patient in the protocol who had followed the regimen in the way they designed it. Everyone else in the study skipped the medication numerous times, which was hardly surprising, given the challenges. (Lack of medical compliance is, in fact, a very pervasive problem.)

      So how did I do it? Did I simply have nerves of steel? No. Like anyone else, I have plenty of problems with self-control. But I did have a trick. I basically tried to harness my other desires in an effort to make the prospect of the terrible injection more bearable. For me, the key was movies.

      I love movies. If I had the time, I would watch one every day. When the doctors told me what to expect, I decided that I would not watch any movies until after I injected myself, and then I could watch as many as I wanted until I fell asleep.

      On every injection day, I would stop at the video store on the way to school and pick up a few films that I wanted to see. I would have these in my bag and would eagerly anticipate watching them later that day. Then, immediately after I took the injection, but before the shivering and headache set in, I jumped into my hammock, got comfortable, made sure the bucket was in position, and started my mini–film fest. This way, I learned to associate the initial injection with the rewarding experience of watching a wonderful movie. Only an hour later, after the negative side effects kicked in, did I have a less than wonderful feeling about it.

      Planning my evenings in this way helped my brain associate the injection more closely with the movie than with the fever, chills, and vomiting, and thus, I was able to continue the treatment.

      DURING THE SIX-MONTH treatment, it looked as though the interferon was working, and my liver function improved dramatically. Unfortunately, a few weeks after the trial was over, the hepatitis returned, so I started a more aggressive treatment. This one lasted a year and involved not only interferon but also a drug called ribavirin. To compel myself to follow this treatment, I again tried the injection-movie-hammock procedure as before. (Thanks to my somewhat faulty memory, I was even able to enjoy some of the same movies I had watched during the first treatment with interferon.)

      This time, however, I was also interviewing at various universities for a job as an assistant professor. I had to travel to 14 cities, stay overnight in hotels, give a talk to groups of academics, and then submit to one-on-one interviews with professors and deans. To avoid telling my prospective colleagues about my adventures with interferon and ribavirin, I would insist on a rather strange schedule of interviews. I routinely had to make some excuse about why I arrived early the day before the interview but could not go out for dinner that evening with my hosts. Instead, I would check into the hotel, take out the injection from a little icebox that I carried with me, inject myself, and watch a few movies on the hotel television. The following day I would also try to delay the interviews for a few hours, but once I felt better I would go through the interview as best I could. (Sometimes my procedure worked; sometimes I had to meet people while I still felt wretched.) Fortunately, after I finished my interviews I received excellent news. Not only had I been offered a job, but the combination treatment had eliminated the hepatitis from my liver. I’ve been hepatitis-free ever since.

      THE LESSON I took away from my interferon treatment is a general one: if a particular desired behavior results in an immediate negative outcome (punishment), this behavior will be very difficult to promote, even if the ultimate outcome (in my case, improved health) is highly desirable. After all, that’s what the problem of delayed gratification is all about. Certainly, we know that exercising regularly and eating more vegetables will help us be healthier, even if we don’t live to be as old as the Delany sisters; but because it is very hard to hold a vivid image of our future health in our mind’s eye, we can’t keep from reaching for the doughnuts.

      In order to overcome many types of human fallibility, I believe it’s useful to look for tricks that match immediate, powerful, and positive reinforcements with the not-so-pleasant steps we have to take toward our long-term objectives. For me, beginning a movie—before I felt any side effects—helped me to sustain the unpleasantness of the treatment. As a matter of fact, I timed everything perfectly. The moment I finished injecting myself, I pressed the Play button. I suspect that had I hit Play after the side effects kicked in, I would not have been as successful in winning the tug-of-war. And who knows? Maybe if I had waited for the side effects to kick in before I started the movies, I would have created a negative association and would now enjoy movies less as a consequence.*

      ONE OF MY colleagues at Duke University, Ralph Keeney, recently noted that America’s top killer isn’t cancer or heart disease, nor is it smoking or obesity. It’s our inability to make smart choices and overcome our own self-destructive behaviors.¹⁰ Ralph estimates that about half of us will make a lifestyle decision that will ultimately lead us to an early grave. And as if this were not bad enough, it seems that the rate at which we make these deadly decisions is increasing at an alarming pace.

      I suspect that over the next few decades, real improvements in life expectancy and quality are less likely to be driven by medical technology than by improved decision making. Since focusing on long-term benefits is not our natural tendency, we need to more carefully examine the cases in which we repeatedly fail, and try to come up with some remedies for these situations. (For an overweight movie lover, the key might be to enjoy watching a film while walking on the treadmill.) The trick is to find the right behavioral antidote for each problem. By pairing something that we love with something that we dislike but that is good for us, we might be able to harness desire with outcome—and thus overcome some of the problems with self-control we face every day.

      Chapter 8

       The High Price of Ownership

      Why We Overvalue What We Have

      At Duke University, basketball is somewhere between a passionate hobby and a religious experience. The basketball stadium is small and old and has bad acoustics—the kind that turn the cheers of the crowd into thunder and pump everyone’s adrenaline level right through the roof. The small size of the stadium creates intimacy but also means there are not enough seats to contain all the fans who want to attend the games. This, by the way, is how Duke likes it, and the university has expressed little interest in exchanging the small, intimate stadium for a larger one. To ration the tickets, an intricate selection process has been developed over the years, to separate the truly devoted fans from all the rest.

      Even before the start of the spring semester, students who want to attend the games pitch tents in the open grassy area outside the stadium. Each tent holds up to 10 students. The campers who arrive first take the spots closest to the stadium’s entrance, and the ones who come later line up farther back. The evolving community is called Krzyzewskiville, reflecting the respect the students have for Coach K—Mike Krzyzewski—as well as their aspirations for victory in the coming season.

      So that the serious basketball fans are separated from those without “Duke blue” running through their veins, an air horn is sounded at random times. At the sound, a countdown begins, and within the next five minutes at least one person from each tent must check in with the basketball authorities. If a tent fails to register within these five minutes, the whole tent gets bumped to the end of the line. This procedure continues for most of the spring semester, and intensifies in the last 48 hours before a game.

      At that point, 48 hours before a game, the checks become “personal checks.” From then on, the tents are merely a social structure: when the air horn is sounded, every student has to check in personally with the basketball authorities. Missing an “occupancy check” in these final two days can mean being bumped to the end of the line. Although the air horn sounds occasionally before routine games, it can be heard at all hours of night and day before the really big contests (such as games against the University of North Carolina-Chapel Hill and during the national championships).

      But that’s not the oddest part of the ritual. The oddest part is that for the really important games, such as the