The Undoing Project: A Friendship that Changed the World(68)

Danny wanted Redelmeier to find him a real-world medical example of what he was calling the “peak-end rule.” It didn’t take long for Redelmeier to come up with a bunch, but they settled on colonoscopies. In the late 1980s, colonoscopies were painful, and not merely dreaded. The discomfort of the procedure dissuaded people from returning for another one. By 1990, colon cancer was killing sixty thousand people every year in the United States alone. Many of its victims would have survived had their cancer been detected at an early stage. One of the big reasons colon cancer went undetected was that people found their first colonoscopy so unpleasant that they elected not to return for a second one. Was it possible to alter their memory of the experience so that they might forget how unpleasant it was?

To answer the question, Redelmeier ran an experiment on roughly seven hundred people over a period of a year. One group of patients had the colonoscope yanked out of their rear ends at the end of their colonoscopy without ceremony; the other group felt the tip of the scope lingering in their rectums for an extra three minutes. Those extra three minutes were not pleasant. They were merely less unpleasant than the other procedure. The patients in the first group were on the receiving end of an old-fashioned wham-bam-thank-you-ma’am colonoscopy; those in the second group enjoyed a sweeter, or less painful, ending. The sum total of pain experienced by the second group was, however, greater. The patients in the second group experienced all the pain that those in the first group experienced, plus the extra three minutes’ worth.

An hour after the procedure, the researchers entered the recovery room and asked the patients to rate their experience. Those who had been given the less unhappy ending remembered less pain than did the patients who had not. More interestingly, they proved more likely to return for another colonoscopy when the time came. Human beings who had never imagined that they might prefer more pain to less could nearly all be fooled into doing so. As Redelmeier put it, “Last impressions can be lasting impressions.”



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Working with Danny was different from working with Amos. Redelmeier’s mental picture of Amos was always crystal clear. Danny left behind a more complicated and murkier impression. Danny was not joyful: Danny was maybe even depressed. He suffered for his work, and so those who worked with him inevitably suffered a bit, too. “He was more likely to see what was wrong with the work and less likely to see what was right with it,” said Redelmeier. And yet what came out of his mind was also, obviously, spectacular.

It was odd, when Redelmeier stopped to think about it, how little he ever learned about Amos’s and Danny’s lives. “Amos told me very, very little about his life,” he said. “He never talked about Israel. He never talked about the wars. He didn’t talk about the past. It’s not that he was deliberately evasive. It’s just that he controlled the agenda.” The agenda, when they were together, was to analyze human behavior in the delivery of health care. He didn’t presume to ask Danny or Amos about their past or their relationship to each other. And so he never found out how or why they had left Hebrew University and Israel for North America. Or why Amos had spent the 1980s as an exalted chaired professor of behavioral science at Stanford, while Danny passed most of that time in relative obscurity at the University of British Columbia. The two men seemed friendly enough, but they weren’t obviously working together: Why was that? Redelmeier didn’t know. “And they wouldn’t talk about each other,” he said.

Instead they seemed to have decided they’d bag more game if they hunted separately rather than together. Both were engaged, in different ways, in extending the ideas that they had given birth to jointly in the real world. “I was thinking they were just buddies and I was their pet schnauzer,” said Redelmeier.

Redelmeier returned to Toronto in 1992. The experience working with Amos had been life-altering. The man was so vivid that you could not confront any question without wondering how he would approach it. And yet, as Amos always seemed to have all the big ideas, and simply needed medical examples to illustrate them, Redelmeier was left with the feeling that maybe he hadn’t done very much. “In many ways I was a glorified secretary, and that troubled me for many years,” he said. “Deep down, I thought I was extremely replaceable. When I came back to Toronto, I wondered: Was it just Amos? Or was there something Redelmeier?”

Still, only a few years earlier, he’d imagined that he might wind up a general practitioner in a small village in northern Labrador. Now he had a particular ambition: to explore, as both researcher and doctor, the mental mistakes that doctors and their patients made. He wanted to combine cognitive psychology, as practiced by Danny and Amos, with medical decision making. How exactly he would do this he could not immediately say. He was still too unsure of himself. All he knew for sure was that by working with Amos Tversky, he had discovered this other side to himself: a seeker of truth. He wanted to use data to find true patterns in human behavior, to replace the false ones that governed people’s lives and, often, their deaths. “I didn’t really know it was in there,” Redelmeier said of this side of himself. “Amos doesn’t uncover it. He implants it. He sends me as a messenger to a land in the future that he will never see.”



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* “Discrepancy between Medical Decisions for Individual Patients and for Groups” appeared in the New England Journal of Medicine in April 1990.