By Steve Kelman

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Short-term pain, long-term gain

steve kelman

About two and a half months ago, I entered the hospital for nine consecutive days of intense chemotherapy designed to kill any remaining cancer cells in my body, accompanied by a stem cell transplant to replace the white blood cells the chemo would kill. The weekend before, I had a “fattening-up dinner” (my orders: to eat steak and a rich dessert) – since the chemo would make me lose my appetite -- with a close friend and colleague from the Harvard Kennedy School, an economist.

At the dinner, my colleague told me how pleased he was I had decided to get the transplant. What fascinated me was his reason. He was afraid that I would look at the short-term risks and costs of the transplant – about 1% of those receiving a stem cell transplant die due to infections they contract when their white blood cell counts are in the basement and the several-month recuperation period, including three months when I couldn’t be in a public place and a full year of various food restrictions (no raw fruits or vegetables, for example) – and discount the long-term benefits, namely a reduction of the likelihood that the cancer will recur. He was concerned I would decide not to get the transplant.

My colleague in fact need not have worried. I am a reasonably intelligent, analytical Harvard professor. There is research on the benefits of stem cell transplants for patients with my kinds of cancer. Although the sample sizes are small (this kind of cancer is quite rare), the results are pretty overwhelming. A transplant has quite a good chance of curing you of the disease, while without a transplant it is likely to recur. Once I read the research, to me my decision was pretty clear.

My colleague was worried anyway because there is lots of evidence that in many situations people are not willing to sacrifice short-term pain even if this pain is likely to produce great long-term benefits. Psychologically, we tend to pay a lot more attention to results of our actions that are immediately visible to us and to pay less attention to more-distant results. This often leads to distorted decisions.

I believe my colleague was concerned with my personal welfare in being happy I made the decision I did, but he is an economist, and his concerns tie in with larger concerns economists typically have when thinking about public policy decisions governments make. He is worried that governments (responding to the views of citizens) are not willing enough to impose short-term sacrifices to achieve greater long-term benefits. With small downward adjustments in various government-provided social benefits (such as social security) now, we could save both the long-term viability of the system and the nation’s fiscal health. With small increases in taxes for the very wealthy, we could improve the nation’s long-term social stability. Somewhat more controversially, many argue that really devastating effects over the longer term of climate change (increased coastal flooding, droughts, wildfires, and food supply disruptions) could be avoided by modest adaptations of our lifestyles and increased prices for energy now.

Can we get Americans to see a little further into the future and be more willing to make a short-term sacrifice for long-term gains, like I did with my transplant? It would be a better country if we can.

P.S. - When I left the hospital seven weeks ago, I couldn’t walk even 10 feet, and that only with a cane. I can now walk over 2 miles at a stretch (though with some rest stops along the way), without cane. Am hoping to return to teaching at the beginning of January.

P.P.S. - Expect my next blog on Monday. After that, I will aim to post Mondays and Thursdays, though sometimes may be only once a week.

Posted by Steve Kelman on Sep 09, 2015 at 6:31 AM


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