Turning the Tides of Behavior: Do the Ends Justify the Means?

Cancer prevention has begun to go the way of pay-for-performance programs. Notably, we have seen the success of Kevin Volpp's group in creating a monetary incentive plan for smoking cessation that proved more effective than many others of its kind. As was noted of his research, the program created some direct incentives for individuals to quit smoking, rather than longer term, less quantifiable results. While there is still some debate about whether such ‘pay-for-performance' programs are indeed effective, such programs beg another question: Have we become forced to bribe each other in order to act in our own best interests? As we pursue other public health concerns, such as cancer prevention, obesity, reducing carbon emissions and ensuring clean water, it is necessary to take stock of how we turn the tides of behavior such that we can ensure good public health in an ethically supportable fashion.