money. If you don’t,
that $5 goes to what
Jordan Goldberg calls
an “anti-charity,” a
group that you have
identified that you
strongly disagree with.
“If you’re for
gun control, you’ll
to keep us from
sending your money
to the National Rifle
Goldberg, adding that
you can choose other
consequences, such as
betting against friends
or sending money to
causes you support.
Video: Click here to get a look at the drug-free workplace designed by
Johns Hopkins psychologists.
These kinds of automated systems are driving the
movement of contingency management from small-scale
studies to major population-level applications, says Joe
Schumacher, PhD, a professor of medicine and contingency
management researcher at the University of Alabama at
“Incentive systems are going high-tech,” he says.
Schumacher is best known for his work using contingency
management to get homeless people with crack addictions to
quit, but he’s now extending that work to larger populations
through a Birmingham-based company called ChipRewards.
ChipRewards recently collaborated with Chattanooga,
Tenn., to create a program for 3,200 of the city’s workers.
They adapted software originally created for business loyalty
programs to monitor how often employees, for example, go
to the gym, refill prescriptions or attend preventative health
screenings. The program automatically issues employees good-behavior points, which can be exchanged online for a variety of
That means the same computer program that encourages
you to eat nine burritos to get one free may soon help you lose
the weight you gained eating all those burritos.
ChipRewards has been hired by several large companies and
is being used by more than 100,000 employees, says Klapow,
ChipRewards’ chief behavioral scientist. In the future, programs
like his could create large-scale medication adherence programs
for pharmacetical companies, since they stand to earn money
if people remember to refill their prescriptions. Adherence also
helps people better manage chronic illness and reduces the
nation’s health-care costs, Klapow says.
Of course, not everyone is enthusiastic about the idea of
having companies electronically monitor and reward healthy
behaviors. It’s one thing to use contingency management to
help people with drug addictions, but it’s quite another to
apply these programs to the wider population, says George
Loewenstein, PhD, a behavioral economics professor at
Carnegie Mellon University.
A case in point, he says, is weight loss. We can pay people to
eat more healthfully — in fact, he did just that in a randomized
controlled trial in the June Journal of General Internal Medicine.
In the study, participants in the contingency management
condition lost an average of eight more pounds than people in
the control condition. But to address widespread obesity, it’s
better to lower the cost of fresh fruits and vegetables and raise
the cost of processed food, he says.
“Contingency management tackles the problem at the
individual level, but we risk losing sight of the real underlying
causes of the problem and possibly even blaming the victim,”
Then, there’s the larger issue of free will. As contingency
management systems spread, will we begin to see ourselves as
nothing more than rats in Skinner boxes?
“There’s the potential of going overboard,” Loewenstein
says. “Ending up in a ‘Walden Two’-type society doesn’t seem
like such a great outcome to me.” n