Mar 13 2017

Reconsidering The Nudge

behavioural_economics_nudgeIn 2008 Thaler and Sunstein published their book, Nudge, advocating for a more nuanced approach to changing public behavior. Since then nudge theory has been quite popular but hasn’t created the revolution optimists had hoped.

Here is the core problem: people do not always act in their own best interest. Sometimes this affects only them, but often the negative impacts affect the people around them, their family, and even society as a whole. An obvious example is vaccinations.

There are many less-obvious examples, however. Poor health care decisions increase the cost of health care, which is a rapidly increasing burden on society. Poor financial decisions can leave people in debt, might cause them to default on those debts, and have an overall negative impact on the economy. We all share risks through insurance premiums and public costs.

And, we actually care about people. We are a social species and we do generally have empathy for others (unless they have been psychologically relegated to an out-group). It is also some people’s job to care about people.

Therefore, for various reasons, there are individuals and groups who care about changing other people’s behavior for their own good and for the good of society. This paternalism runs up against several obstacles.

The first is liberty (which, make no mistake, is a good thing). Consenting adults have the right to make poor decisions, and in a free and open society we recognize that we should tread lightly on the liberty of others. Any time society forces people into good behavior, the benefits have to be carefully weighed against the loss of liberty. Speed limits, seat belt laws, and helmet laws are examples of situations in which we favor safety over liberty (and even then such laws have their vocal critics).

The second obstacle is decision-fatigue. We live in an increasingly complex society, which means the average person is faced with an array of complex decisions on a regular basis. We all can’t be experts in health care, finances, car maintenance, food safety, nutrition, pyramid schemes and other frauds, travel safety, computer and identity threats, etc.

With the internet and mass media we are faced with a dizzying amount of information. Good information is mixed with bad. A lot of the information is just lazy and low quality, and a lot is ideologically biased. People, therefore, will tend to slip into simplistic narratives that give the illusion of simplifying their decision-burden.

So, any public information campaign, even with the best intentions, is just adding to this burden, and is competing with a lot of other sources of information, mostly misinformation.

The third obstacle is that it is just difficult to change people’s behavior. Behavior is the result of innate personality traits combined with a lifetime of habits and a complex web of cultural influences. There is no simple way to alter the resulting behavior.

The default method used by doctors, public service announcements, and advisers is the so-called “scared straight” method. Essentially this assumes that people are rational actors and if we just give them information they will make better-informed, and therefore better, decisions. Another way to look at this approach is that it assumes the problem is a deficit of information, and therefore filling the deficit is the solution.

As I discussed above, however, the problem is just as likely to be an excess of information, and psychological barriers that have nothing to do with information. We want people to say, “Really? Smoking causes cancer!” and then quit. That happens sometimes, but rarely.

Newer approaches include social norming or motivational interviewing. These use psychological pressures to force good behavior. Social norming is an approach public service announcements – instead of scaring people with statistics, tell them that their peers are engaging in good behavior. This seeks to leverage peer pressure toward good behavior.

Motivational interviewing is similar, but on an individual level. You ask people what their goals are and then discuss how to achieve their goals. If they do not engage in the recommended behavior, then they look inconsistent, and people tend to avoid this because it is socially embarrassing.

These methods are more effective than the scared straight approach, but not by much. It is enough to make them worthwhile, but still not what we would like.

This is where the Nudge comes in. Nudging, which some people call libertarian paternalism, seeks to take a minimalist approach that preserves free choice as much as possible. Nudging sometimes involves psychological manipulation, like social norming. It also makes use of default behavior.

For example, instead of requiring employees to opt in to a retirement plan, they are signed up by default and then have to opt out. They still have the free choice, but the default decision is the one deemed in their best interest.

Such nudging can take many forms. My cafeteria at work now offers you vegetables (like carrot sticks) as an accompaniment to your sandwich, rather than potato chips. You can still buy the potato chips if you want, but there isn’t someone offering to put a big helping onto your plate. Fast food restaurants can have their meal packages come with apple slices instead of fries. You could still buy the fries a-la-cart, but they aren’t offered to you, nor are you encouraged to “supersize”.

Nudging works, in that it does have an immediate effect on behavior. After a decade of further research, however, the limits of nudging are becoming more clear. In a recent review of the topic for Science News they discuss the many unintended consequences of nudging.

For example, reminding donors who gave to a charity in a previous year to donate again does result in a pulse of donations, but also results in a pulse of people unsubscribing from the e-mail list.

Signing up for a retirement plan by default does get more people to sign up, but sometimes they are defaulted into a plan that is not optimal for their situation, causing later regret.

Many of these issues are solvable with more sophisticated and evidence-based campaigns. Still, the data shows that nudging typically has short term behavioral changes only. It is no surprise that you cannot have a dramatic effect on people’s behavior which is based on years of habit, culture, and innate tendencies.

It is also perhaps not surprising that marketers are way ahead of the game of changing people’s behavior. While psychologists and policy makers are struggling to make small positive changes to behavior, the marketing and advertising worlds have already worked much of this out. The placement of products on store shelves, for example, is all about nudging. Commercials employ tactics of social norming and motivational techniques.

Marketing campaigns are about creating a culture in which their product is viewed as having a health-halo, or being part of a cool or rugged identity. Have you noticed that many commercials are very light on information but heavy on selling an image or an idea? The marketplace has already worked out how to influence people’s behavior – at least their buying behavior.

Entire movements and industries are based upon this. The organic food industry is a giant scam, for example, but they have manufactured a health halo out of misinformation, demonizing their competitors, stoking fears, and playing off the appeal to nature. This has worked.

Marketing campaigns, however, are viewed with special suspicion when they come from the government (perhaps they should be), or when we are being told that something is for our own good. Even if we try to adopt the knowledge of the marketing industry, getting people to engage in behavior that is in their own interest still hits psychological barriers.

There is no easy solution to this. Life is complex, and no one method will replace the effects of taking a knowledgeable and active role in taking care of every aspect of your life. There is no shortcut.

Policies to improve behavior, therefore, have to be equally complex. They need to consider human psychology, culture, unintended consequences, decision-fatigue, and many other factors. The most effective methods seems to be to change the culture itself, but this is incredibly hard and takes a long time. Any such efforts are also competing with many others who want to influence the culture to their own selfish or ideological ends.

As individuals we need to also take a complex approach. This means picking our battles, being sensitive to diminishing returns, finding good sources of information, and questioning our own beliefs.

40 responses so far

40 Responses to “Reconsidering The Nudge”

  1. MWSlettenon 13 Mar 2017 at 8:48 am

    Speed limits, seat belt laws, and helmet laws are examples of situations in which we favor safety over liberty (and even then such laws have their vocal critics).

    Speaking of nudging, I’ve heard it said if you really want safer drivers get rid of seat belts and airbags and install a long metal spike in the middle of the steering wheel pointed at the driver’s heart.

  2. Atlantean Idolon 13 Mar 2017 at 9:35 am

    Speaking of nudging, I’ve heard it said if you really want safer drivers get rid of seat belts and airbags and install a long metal spike in the middle of the steering wheel pointed at the driver’s heart.

    This a classic example of moral hazard given in Econ 101. People (men especially) tend to drive more recklessly when they believe they are protected in some way in the event of an accident. Other possible disincentives include letting emergency room triage deprioritize those who behave irresponsibly and decollectivizing health insurance to make individuals bear a greater cost of their decisions.

  3. banyanon 13 Mar 2017 at 10:34 am

    Moral hazard is real, but it’s been my experience that those worried about it are too often weighting it far too high, or flat out ignoring the benefits of the policy in question.

    For example, getting rid of seatbelts and airbags would probably result in “safer drivers,” yes. However, it would make the accidents that do happen far more likely to be fatal or at least more injurious. There’s a good chapter on moral hazard and ignoring the benefits side of a cost-benefits equation in the book Economics Without Illusions by Joseph Heath.

  4. SteveAon 13 Mar 2017 at 10:47 am

    MWSletton/Atlantean Idol

    To continue on the theme, there’s evidence that cyclists take more risks if they’re wearing a helmet, and also that drivers are less careful in their interactions with helmeted cyclists as opposed to bare-headed ones, who are perceived as being far more vulnerable (Drivers overtaking bicyclists: Objective data on the effects of riding position, helmet use, vehicle type and apparent gender. Accident Analysis & Prevention. Volume 39, Issue 2, March 2007).

    The moral, I suppose, being – be careful what you nudge for.

  5. David Pritchardon 13 Mar 2017 at 12:34 pm

    Typo: “Singing up for a retirement plan”

  6. bendon 13 Mar 2017 at 12:35 pm

    SteveA,
    “there’s evidence that … drivers are less careful in their interactions with helmeted cyclists as opposed to bare-headed ones, who are perceived as being far more vulnerable”
    I’ve read that paper. I wondered if the drivers’ actions may have something to do with the frequency of seeing a cyclist without a helmet vs one with a helmet. Could it be that helmeted riders are relatively common and that seeing one without a helmet or one with long hair blowing in the wind simply makes a motorist more conscious of the cyclist generally? Is it a questions of the rider being perceived as more vulnerable or simple a matter of being perceived at all? Would wearing a fluorescent helmet with a blinking LED have a similar effect? Or would riding naked but for a helmet be safest of all?

  7. SteveAon 13 Mar 2017 at 12:50 pm

    bend

    Good questions, but I find it hard to believe that wearing a helmet would make you less noticeable than not…

    I would, however, endorse your nude cycling suggestion (a certain ‘Queen’ song springs to mind) though given the number of paunchy (currently lycra-clad) middle-aged men wobbling about on the roads, I might come to regret it.

  8. hardnoseon 13 Mar 2017 at 1:12 pm

    “We are a social species and we do generally have empathy for others (unless they have been psychologically relegated to an out-group).”

    Liberals have empathy for every human being, except those that are not liberals.

  9. hardnoseon 13 Mar 2017 at 1:16 pm

    [We want people to say, “Really? Smoking causes cancer!” and then quit. That happens sometimes, but rarely.]

    Smoking has decreased drastically, because there is clear evidence. People do listen to good advice, when they are sure it is good advice.

  10. zorrobanditoon 13 Mar 2017 at 1:23 pm

    Apples/french fries. I have not encountered this piece of nonsense (yet) but I imagine I will resent it when I do.

    I like apples fine. But if I’m eating at McD’s, which I do rarely, I’m not there for my health. I’m an adult, and the landscape here in Northern California is strewn with healthy-food, organic, vegan, you-name-it Righteous Restaurants.

    I’m at McD for a reason. And I like french fries, quite a bit. I will certainly buy the fries separately the first time someone tries to foist this piece of Nanny-State at me, but that will be my last trip to McD.

    For future meals when I am in the junk-food mood, I will find a junk food restaurant that includes the fries.

  11. hardnoseon 13 Mar 2017 at 1:26 pm

    Scaring people works. Millions of Americans have been scared into taking statin drugs, even without any good evidence that they are safe an effective for most patients.

    You just have to scare them enough, they will do anything.

  12. Steve Crosson 13 Mar 2017 at 1:49 pm

    Speaking of nudging, I’ve heard it said if you really want safer drivers get rid of seat belts and airbags and install a long metal spike in the middle of the steering wheel pointed at the driver’s heart.

    Just because you’ve heard something said, doesn’t make it true — for either you or President Drumpf.

    As Steve N. already pointed out, people are not particularly good at personal risk assessment. They ARE good at rationalization to justify their desired behavior. Which is exactly what the above comment sounds like. An anecdotal/hypothetical situation which has just enough superficial plausibility to allow self justification. Or for someone to jump on the libertarian bandwagon.

    I’m completely in favor of as much personal liberty as possible. The problem is that it is often difficult or impossible to separate personal actions from their (potentially huge) public impact.

    Other possible disincentives include letting emergency room triage deprioritize those who behave irresponsibly and decollectivizing health insurance to make individuals bear a greater cost of their decisions.

    How in the hell is an ER doc supposed to tell if the latest helmet-less victim was driving recklessly or was hit by someone else driving poorly? Especially in time critical situations or triage?

    The same problems occur in many other circumstances, including health care. Some people do everything humanly possible to live a “healthy lifestyle”, but they still get cancer.

    Sorry, children in particular need some paternalistic oversight. And we ALL act childish in some areas of our behavior. A little help from society is a good thing if we can figure out how to do it effectively.

  13. MaryMon 13 Mar 2017 at 3:54 pm

    The organic food industry is a giant scam….

    Totally agree here. And the problem is that science doesn’t have a marketing team. The government can’t come out and call them a scam, they support the organic industry with the halo-generating programs.

    But science is–as you’ve said before, Steve–lining up in red coats while the quacks and marketers don’t have any barriers or hesitations for making their case. And they have big marketing budgets to do it. Their crank ads will follow you around the web, continually making “impressions” that they have plenty of money for.

    Nobody markets science and skepticism. And most skeptics and scientists don’t want to touch marketing with a 10-foot pole.

    Still, I’d support a science nudge program. It’s worth a try, nothing else is working.

  14. hardnoseon 13 Mar 2017 at 6:11 pm

    I went to get a checkup recently, and everyone working in the office was fat — receptionists, nurses, medical assistants, doctors.

    So how can they expect patients to take their advice?

  15. MWSlettenon 14 Mar 2017 at 9:01 am

    Steve Cross: An anecdotal/hypothetical situation which has just enough superficial plausibility to allow self justification.

    Or maybe it was a bit of lighthearted fun?

    Steve Cross: Or for someone to jump on the libertarian bandwagon.

    Lighten up Francis. Why not wait for me say something REALLY offensive before starting with the labels?

    Steve Cross: Sorry, children in particular need some paternalistic oversight. And we ALL act childish in some areas of our behavior. A little help from society is a good thing if we can figure out how to do it effectively.

    Where were you when I proposed to my first wife? THAT’S when I could’ve really used a little help!

  16. Atlantean Idolon 14 Mar 2017 at 10:20 am

    How in the hell is an ER doc supposed to tell if the latest helmet-less victim was driving recklessly or was hit by someone else driving poorly? Especially in time critical situations or triage?

    Riding helmet-less is stupid regardless of how recklessly anyone drives. The paramedic can slap a big red sticker on anyone found not wearing a helmet or seat belt. BTW, I’m not arguing against helmet/seatbelt laws per se. I would only consider them, however, under a fully free market in health care, where people could properly weigh the benefits of natural selection against the costs of increased demand for trauma treatment.

  17. BillyJoe7on 14 Mar 2017 at 2:12 pm

    Emergency staff prioritise according to the level of medical emergency.
    Despite what those with ideological blinders would wish, I hope that never changes.

  18. Atlantean Idolon 14 Mar 2017 at 3:52 pm

    those with ideological blinders

    This is rich coming from someone who attempted to defend private property smoking bans on the grounds that the state confiscates earnings to pay for others’ health care and thinks that total prohibition would be justified if only the state could get away with it:

    The fact of the matter is this: smoking is bad for your health and it is difficult to smoke without harming others. Everyone of us pays for this harm through direct or indirect harm to our health and most of us pay taxes used to treat the harm, therefore Governments have a responsibility to act. An outright ban on smoking is impractical and doomed to fail, so governments should do all they can, short of an outright ban, to reduce smoking.

  19. BillyJoe7on 14 Mar 2017 at 4:06 pm

    Where’s the ideology?

  20. BillyJoe7on 14 Mar 2017 at 4:41 pm

    …Ive gone from evidential science to practical politics!

  21. Ivan Groznyon 14 Mar 2017 at 10:30 pm

    “The most effective methods seems to be to change the culture itself, but this is incredibly hard and takes a long time. Any such efforts are also competing with many others who want to influence the culture to their own selfish or ideological ends.”

    Yes, what could possibly go wrong with this? You, good, right-thinking people who know what’s best for all those stupid rubes should “change the culture” (A modern PC talk for the old god Stalinist building of a “new man”). But alas, other, not good and not right-thinking people, possessed by selfishness and ideology don’t wanna give up and compete with you. This is getting beyond parody.

  22. BillyJoe7on 14 Mar 2017 at 11:13 pm

    ^talk about ideology and parody 😀

  23. Lightnotheaton 15 Mar 2017 at 12:12 am

    What could possibly go wrong with eschewing any attempt at culture change in order to avoid being a (shudder) Stalinist new-man builder? Well, maybe thousands of preventable deaths from lung cancer, emphysema, etc., but hey, at least I’m not a totalitarian!

  24. Steven Novellaon 15 Mar 2017 at 8:22 am

    Ivan – you see what you want to see. Right – we should only let entertainment and corporations change the culture for their own ends. Let’s never try to change the culture in an obviously beneficial direction – such as not promoting smoking as being cool, rugged, or independent.

    AI – “emergency room triage deprioritize those who behave irresponsibly”

    That would be grossly unethical and will never happen, nor should it. Talk about moral hazard – this runs directly against professional ethics. Can you imagine a world in which your doctor judges you, and prioritizes your care based upon how much he thinks you are responsible for your bad health?

  25. Atlantean Idolon 15 Mar 2017 at 12:11 pm

    BJ:

    Where’s the ideology?

    You’re blind to it because you see everything through it – “it” being the win/lose victimhood mentality of the collectivist interpretive framework. I, by contrast, don’t proselytize my ideology while arrogating to myself some imaginary mantle of enlightened post-ideologue. I’m a proud, rabid, radical capitalist – I don’t even reject the label of “extremist”- I have no desire to moderate my pursuit of peace, justice, liberty, prosperity, health and happiness. In this pursuit, I use the best evidence available from the best experts whom I regard as trustworthy advisers, not technocratic authorities. I’m a 100% factual free-market fundamentalist – I accept the facts of reality as they are, including the fact that I value individual liberty to a maximal degree. Laissez-faire, by definition, is the only system that fully safeguards individual liberty. Ultimately the distinction between fact and value, is and ought, is illusory. I think discussions of this kind would be much more productive if everyone were upfront about their individual values and stop pretending that everyone else shares them.

    SN:

    this runs directly against professional ethics.

    If so I don’t care much for present medical ethics in this regard. The solution is to replace medical licensing with certification so I can see physicians whose ethics are consonant with mine.

    As to the whole nudge matter, the Science News article mostly confirms what economists already know – that any action, even one as subtle as reframing options rather than restricting them, involves trade-offs. The difficulty lies in identifying them and measuring their magnitudes.

    SN & IG: Change the culture all you want by peaceful persuasion – never at the point of a gun, which is what the government is. No one can think (i.e. live) at gunpoint – for this reason I want the government completely out of the world of ideas – including science.

    If I were king of the world and the entire Eastern Hemisphere were to succumb to Japanese suicide culture I would not use the power of the state to stop it. Man’s life is his own, and it is his right alone to destroy it.

  26. chikoppion 15 Mar 2017 at 12:44 pm

    [Atlantean Idol] If so I don’t care much for present medical ethics in this regard.

    Um. Are you saying what you appear to be saying? That a medical professional should provide a lower standard of care based on a tenuous and subjective assessment of the patient’s recent behavior?

  27. Atlantean Idolon 15 Mar 2017 at 1:04 pm

    Um. Are you saying what you appear to be saying? That a medical professional should provide a lower standard of care based on a tenuous and subjective assessment of the patient’s recent behavior?

    I’m saying that if some cretin driving under the influence without his seatbelt on collides with my car and we’re both taken to an ER with only one available bed, that bed is MINE. If the other guy dies good riddance.

  28. chikoppion 15 Mar 2017 at 1:31 pm

    [Atlantean Idol] I’m saying that if some cretin driving under the influence without his seatbelt on collides with my car and we’re both taken to an ER with only one available bed, that bed is MINE. If the other guy dies good riddance.

    No you’re not. You’re saying medical professionals should be free to determine standard of care on a whim.

    You go out with friends and are walking to get a taxi. A texting driver plows into you and then hits a wall and is ejected from the car. Responders don’t know what happened on scene and report to the ER staff only that it appears a driver hit pedestrians. The ER staff checks your blood alcohol, assumes you’re the guilty party, and leaves you to expire on a gurney in the hall.

    Or how about the EMT or ER staff is racist and decides to prioritize the other guy because “personal liberty” and such. Sucks to be you.

  29. Lightnotheaton 15 Mar 2017 at 1:42 pm

    Atlantean idol – you are right to say that billyjoe7 has an ideology and should acknowledge that, and I think his ideology makes him use motivated reasoning to some extent. As Dr. Novella has said (I’m paraphrasing,), ideology is an enemy of truly skeptical thinking. That said, some ideologies are worse than others in terms of how much they distort our thinking, and your individual-rights-trump-everything-else ideology is one of the worst offenders in this regard.

  30. BillyJoe7on 15 Mar 2017 at 4:24 pm

    Lightnotheat,

    My beliefs are based in science with the strength of these beliefs being in proportion to the plausibility and the evidence for these beliefs, And my politics are pragmatic. If wanting politics to improve, in a practical way, the position of everyone in society with special consideration of minority groups (because they tend otherwise to be marginalised) is ideology then okay, I raise my hand. But, in my opinion, that the opposite of ideology.

    AI is the epitome of an ideologue. He sticks to his ideology no matter the consequences. His ideology forces him into that ludicrous and indefensible position regarding medical care. Only ideology can lead someone to the conclusion that doctors should treat patients based on the “worth” (who’s to judge?) of the individual rather than medical need, and only an ideologue can believe this can actually be achieved in any practical way.

    In AI’s world, your genes and your environment are your fault, and those with the advantage of good genes and environment are given even more advantage and free license to exploit those with disadvantage. Only an ideologue could think this is a good thing.

  31. Lightnotheaton 15 Mar 2017 at 8:33 pm

    Billyjoe7-
    It’s impossible to completely escape from ideology and bias, and ones own bias is especially the hard to recognize. I think AI’s argument that the self-described enlightened, reasonable enemies of ideologues are themselves ideologues is valid. But for me the key word in your post was “pragmatic,” your ideology allows a lot more room for changing your mind than his does. As I said, for him one thing trumps everything else, and then you have to distort everything to justify keeping that thing paramount at all costs. An example of the same kind of one-thing-trumps-all-else ideology from the other end of the political spectrum is the idea that economic equality trumps everything. As in, we must have a 100% command economy, otherwise some slight degree of class difference might creep in.

  32. BillyJoe7on 16 Mar 2017 at 5:48 am

    I don’t quite get it.
    You’re saying I’m ideological in my opposition to ideology?
    That’s like finding fault with someone who is tolerant except when it comes to intolerance.

  33. Atlantean Idolon 16 Mar 2017 at 9:28 am

    @Chick: Did I mention that I happen to work at a hospital? Sweet dreams, snowflake.

  34. Atlantean Idolon 16 Mar 2017 at 10:11 am

    @LNH:

    your ideology allows a lot more room for changing your mind than his does.

    Many prominent free market economists who were interventionists early in their lives changed their minds the further they progressed into their research: F.A. Hayek, Milton Friedman, and Murray Rothbard, to name a few. Conversely, I know of no prominent free market economist who converted to interventionism on empirical grounds. Something to ponder…

  35. Steve Crosson 16 Mar 2017 at 10:59 am

    Atlantean Idol,

    Just out of curiosity, how many days has it been since you finished reading Atlas Shrugged? And not for the first time, I’ll wager.

  36. chikoppion 16 Mar 2017 at 11:21 am

    [Atlantean Idol] Did I mention that I happen to work at a hospital? Sweet dreams, snowflake.

    What possible bearing does that have on the ridiculousness of your position on this issue, snowflake?

    Putting health care providers in a position to adjudicate innocence or guilt as well as placing them in a position of assigning punitive measures constitutes an extra-judicial process occuring without oversight or due process.

  37. BillyJoe7on 16 Mar 2017 at 2:17 pm

    Well, he didn’t say in what capacity, so let’s hope he’s just a porter.

  38. Rogue Medicon 16 Mar 2017 at 2:20 pm

    The original paper by Walker on the driving behavior of motorists around bicyclists, based on helmet use, distance from the curb, and gender has been followed by a reanalysis of the data, which came to a different conclusion –

    Conclusions

    After re-analysis of Walker’s data, helmet wearing is not associated with close motor vehicle passing. The results, however, highlight other more important factors that may inform effective bicycle safety strategies.

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3783373/

    For those opposed to improved safety measures, the fatality rate keeps dropping, even though we drive more.

    Seat belts save lives.

    Helmets save lives.

    Whatever small safety trade-off is made, by some people, appears to be dwarfed by the improvement in safety.

    This appears to be an appeal to the Good Old Days, which were not as good as their nostalgia suggests.

    Regulations can be excessive, but the conclusion that regulation should be eliminated, rather than modified, is just plain foolish.

    .

  39. Rogue Medicon 16 Mar 2017 at 2:43 pm

    Atlantean Idol,

    @Chick: Did I mention that I happen to work at a hospital? Sweet dreams, snowflake.

    You do not appear to be familiar with medical ethics.

    Otherwise, Dr. Novella would not have needed to correct your misrepresentation of medical ethics.

    Unfortunately, there are plenty of unethical doctors, nurses, paramedics, et cetera.

    .

  40. BillyJoe7on 16 Mar 2017 at 4:31 pm

    I’m not sure porters need to know much about medical ethics.

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