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Freakonomics: How we sell pain

Maxi Rodriguez of Liverpool is injured during the Barclays Premier League match between Chelsea and Liverpool at Stamford Bridge on February 6, 2011 in London, England.

TEXT OF INTERVIEW

Kai Ryssdal: It's time once again for a little bit of Freakonomics Radio. It's that moment every two weeks, where we talk to Stephen Dubner. He's the co-author of the books and the blog of the same name. It is the hidden side of everything.

Dubner, welcome back.

Stephen Dubner: Hey, thanks Kai. I would like to start off with giving you a little something usually. Today, it's not a gift. Today, I brought you something that I sincerely hope never happens to you.

Jack Hillen: My jaw has a big crack right here and they put two plates and 12 screws. It shattered, like my bottom five teeth got knocked out. They were sitting in my throat, I could feel 'em. The oral surgeon that it looked like a gunshot wound.

Ryssdal: All right, well, clearly, I guess it wasn't a gunshot wound, since the surgeon said it looked like that. Did he get hit by a bus or something?

Dubner: Yeah, it sounds like it. But this injury is a result of hockey-puck-meets-face. That was Jack Hillen who you heard speaking. He's a defenseman for the New York Islanders hockey team. Just five weeks after that injury, Hillen was back out there on the ice playing. And it made me wonder Kai, when it comes to pain, how can people like you and me kinda tap our inner hockey player?

Ryssdal: Well, so here's the thing: One is I'm reasonably tough for a public radio host. I mean, I've got a high-pain threshold. But NHL players are probably tougher and also they get paid to take the pain.

Dubner: Those are both true. Here's what I wanted to figure out: When you know something is going to hurt -- whether it's a puck to the face or something more abstract -- how do you nevertheless get people to do it? So I found one answer, strange as it may seem, in your colon. Not your color necessarily...

Ryssdal: Oh man...

Dubner: But colons in general.

Ryssdal: All right, it's a family show, just remember that.

Dubner: We'll keep it clean from here on out. I want you to listen to Donald Redelmeier, who's a doctor in Sunnybrook Hospital in Toronto, who conducted some truly fascinating research on people who are having colonoscopies.

Donald Redelmeier: Probably the single most practical thing is to slow down towards the end of the procedure, so that you give them a sense of mildness. Those last impressions can be lasting impressions.

Ryssdal: One would hope they would slow down for the entire procedure, not just the very end. But what's he really talking about?

Dubner: Well, his point is that pain is important, but what's maybe just as important is how people remember pain -- how they process it and how they remember it. So, what he discovered in this experiment is that people tend to remember the peak moment of pain much more than the average amount of pain. So, in that peak moment, how bad it was informs how people assess the entire experience. Also, because those -- as he puts it -- those last impressions or lasting impressions, he found that if a doctor just leaves the colonoscopy scope inside the patient for a few extra minutes at the end -- when it's causing no pain -- the patient will alter judge the entire experience as being more pleasant, even though it took longer. And that's really important, because a patient with a good memory of a colonoscopy is about 20 percent more likely to return when they need the next one, which is very significant if you're trying to help people detect colon cancer.

Ryssdal: Yeah, that makes a lot of sense. I'm not sure I buy the whole "longer is better" thing, but we'll take that argument at its face. But let me ask you sort of a transition question here, if I might: This is very real, physical pain you're talking about. We on this broadcast talk about abstract pain a lot, specifically financial pain -- the president wants to cut the budget, Congress is having conversations about this, states are out of money, households don't have any money these days -- make that connection for me.

Dubner: Right. Well, I tried to make the connection, I took with Dr. Redelmeier taught us and I went to Gov. O'Malley -- Martin O'Malley -- of Maryland, which is like a lot of states facing a big budget gap, $1.4 billion or 10 percent. So he's gotta sell his constituents on the pain of those cutbacks. So I asked Gov. O'Malley, you know, I told him about Redelmeier's study and I said, how do you plan to sell this pain?

Martin O'Malley: I've been well-advised not to use the word "pain," not to use the word "painful." Those words cause pain and those words are painful.

Ryssdal: Yeah, so that was what four pains and painfuls by a guy who's told not to talk about it?

Dubner: Which would connote that denial is a very important piece of pain-dishing strategy. But just to show you how much discipline the governor has, when he gave his State of the State address last week, how many times, Kai, do you think he actually did use the word pain?

Ryssdal: Yeah, gotta be zero, right? He's a politician.

Dubner: Zero. He was very disciplined, so he's a good politician in that regard. Instead, he told the voters that what they had to expect was tough choices and difficult decisions -- the typical playbook of government euphemism. It's kinda like when your doctor says, "Come on in, Kai, this won't hurt a bit!"

Ryssdal: Yeah, as he snaps on the rubber gloves, right? As we say good-bye here, Dubner, just remember this: Those last impressions, they're lasting impressions. So be nice on the way out, will ya?

Dubner: Well, that being the case Kai, let me just say that I love you, man.

Ryssdal: Aw, dude, I love you too. Uh, no. Get outta here. Stephen Dubner, FreakonomicsRadio.com. He's back in a couple of weeks. See ya.

Dubner: OK Kai, take care.

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