MASTERMIND: Dr. Peter Ubel

Think about your favorite snack food. Think about how often and how much you eat of it, despite the knowledge that it's probably not very good for your health. Obviously, you're not alone. The snack food industry generates billions of dollars in revenue every year. It is the result of incredible innovations in food technology, creating a product that's cheap, dense in calories, stores easily, requires little preparation and cleans up quickly. Who wouldn't be sold on such a product?

Unfortunately, snack food is also a major contributor to our nation's obesity epidemic, leading to an increase in everything from heart disease to diabetes.

"The result is we're heavier than we've ever been before," warns Doctor Peter A. Ubel. "We may actually be the first generation to live shorter than our parents did."

The science of happiness

Whether its eating another handful of Pringles or electing to undergo chemotherapy, how people make the choices they do impacts healthcare and its policies. As Director of the University Of Michigan's Center for Behavioral and Decision Sciences in Medicine, Dr. Ubel and his colleagues spend a lot of time investigating the decision-making processes people go through when confronted with choices about their health. It's a research focus that didn't really exist before Ubel came to Ann Arbor in 2000.

"We had this great medical school and great social sciences program and there was almost no interaction," Dr. Ubel explains. "So, one of the first things I did when I came here was to get social scientists to start working with clinicians. Now the medical school has primary appointments for people doing research on social psychology, cognitive psychology and behavioral economics as related to healthcare. There are very few places that do what we do."

The discoveries have been both surprising and profound, particularly when related to a patient's ability to predict what course of action will make them happiest in life.

"Not only can't people predict what will make them happy," Dr. Ubel says, "but after they've gone through an experience, if you ask them how it made them feel, they're just as inaccurate as they were when they were mis-predicting."

As an example Dr. Ubel explains how studies demonstrated how young people predict they'll be miserable when they get older. Yet when researchers surveyed young and old subjects about the quality of their life, older people are just as, or even happier, than younger people. More startling was that most of the older subjects believed they were even happier when they were younger.

"We have these theories about what matters in life and it's not always what we think," Dr. Ubel explains.

The implications for healthcare policy are obvious. Ubel believes that you should actually find out how someone affected by an experience when setting forth a healthcare policy. 

"It's an important part of the equation," Dr. Ubel says. "Healthcare economics has a tendency to say, 'who cares how people actually feel, let's look at how they think they'll feel. That's what ought to guide policy'. In other words, if I think I'll be miserable with a particular disability we should then spend a lot of money preventing you from getting that disability. But when I ask, 'what if people with that disability aren't really miserable?' Economists reply that it doesn't matter."

But Ubel believed it did, and so he focused his research on why people have such different perceptions about their experiences? He looked at how their emotions responded to adversity, whether they predicted accurately about how they'd respond, and how they remembered it.

It's a focus that has drawn interest and grant support from the National Institute For Health, the Department Of Veteran Affairs and, recently, the World Economic Forum, where Ubel sits on a newly formed global health council with former FDA Commissioner Mark McClellan and David Cutler who is Barack Obama's senior health advisor.

It's also lead to important collaborations with researchers at Michigan State University, as well as Victor Strecher, a professor at the university's School Of Public Health who founded Healthmedia, a successful Ann Arbor company that develops online health behavior tools for patients.

The big picture

When he first arrived, Dr. Ubel's perspective may have seemed novel to U-M's Department of Internal Medicine, but really it was an obvious extension for someone who had gotten his undergraduate degree in Philosophy.

"While I was at Carleton College my father used to ask, 'what would you do with a philosophy major?'," Dr. Ubel recalls. "And I would answer, 'what would I do without one?'"

Seeing medicine as a mix of science and the humanities, he was disappointed to discover that his training at the University Of Minnesota's med school ignored big picture issues like healthcare economics, the ethics of policy and patient experience. So, Dr. Ubel continued his studies in ethics at the University Of Chicago and went on to research the economic implications of medical ethics at Carnegie Melon.

Before U-M came calling, he had spent six years at the University Of Pennsylvania studying the moral issues associated with healthcare rationing.

"If there's a theme that goes through my research it's that we all have difficult decisions to make in healthcare, especially when it comes to spending dollars wisely, " Dr. Ubel explains. "A lot of them hinge on our values and the tradeoffs that are required. Even if we know all the facts there's no obvious right or wrong decision."

It was this research that prompted him to write his first book, Pricing Life: Why It's Time for Health Care Rationing. An academic examination of healthcare rationing, Dr. Ubel found the process of pulling together his research and opinions into a coherent whole immensely gratifying.

"I wanted to write more books that appealed to general readers after that," Dr. Ubel says.

In 2006 the healthcare researcher published You're Stronger Than You Think, which examined how people respond when they face adversity. The book focused on the science of happiness and emotional resilience woven together with stories of people who had gone through a major health crisis.

Dr. Ubel has also become a regular contributor to the Huffington Post, weighing in on healthcare policy issues and the politics behind them. And this January, he further expands his subject repertoire with the release of Free Market Madness, a critique of neoclassical economics. Dr. Ubel goes after the idea that rationale behaviors are at the core of economics and that markets are the best way of having people get what they want out of life.

"The problem with this truism is that it doesn't capture the full spectrum of human nature, which includes a lot of really bizarre irrationalities," Dr. Ubel rationalizes. "When you compound these strange behaviors with marketers, who know the basics of human nature better than we do, the results can be a disastrous."

Told from mostly a healthcare perspective, Dr. Ubel is clearly branching out with regard to his focus of study. It even prompts him to reflect on the country's recent financial crisis and its ethical implications.

"The current economic crisis wasn't just from simple greed, as some have suggested, but rather the consequences of herd mentality," Dr. Ubel offers. "These financial institutions looked across at their peers and saw how they were behaving and concluded that the irrational decisions they were making must have been okay. Social psychology influenced the choices these people made, it wasn't just that they said, 'hey, the government will bail us out if we tank.' What really happened was a string of really irrational behaviors that weren't put into check. Economics says, 'oh, well, in the long run the market will correct itself'. But how many people end up suffering for the decisions of a few?"

The local view

Given his intense focus on quality of life issues and the perceptions people have about their situations (and understanding how unreliable that assessment may be), it seems only fair to ask Dr. Ubel how he views life in Ann Arbor.

"I think any place you can have a 10 minute commute is important to your quality of life," he answers. "The great neighborhoods, the great homes, the restaurants per capita, they all make it easy to recruit people here. As long as you avoid February."

Any down sides?

"There's a research study I've always wanted to conduct…" Dr. Ubel offers. "It's sometimes hard to recruit single people --especially single woman to junior faculty positions. And it's because they look at Ann Arbor and think there's so few people to meet. That's why they gravitate to NY or LA or Chicago. Yet every woman I've recruited that was single got married to someone they met here within a couple of years of arriving. My theory is that these people mis-predict how easy it is to meet a soul mate in Ann Arbor. They think it's about the size of the sea. But they're not considering whether the fish you meet in the sea will be like you, and whether all those other fish in the sea'll distract them."