The (Honest) Truth About Dishonesty

Most of us tend to think that the longer we are in a relationship with our doctors, accountants, financial advisers, lawyers, and so on, the more likely it is that they will care more deeply about our well-being, and as a consequence, they will more likely put our needs ahead of their own. For example, imagine that you just received a (nonterminal) diagnosis from your physician and you are faced with two treatment options. One is to start an aggressive, expensive therapy; the other is to wait awhile and see how your body deals with the problem and how it progresses (“watchful waiting” is the official term for this). There is not a definite answer as to which of the two options is better for you, but it is clear that the expensive, aggressive one is better for your physician’s pocket. Now imagine that your physician tells you that you should pick the aggressive treatment option and that you should schedule it for next week at the latest. Would you trust his advice? Or would you take into account what you know about conflicts of interests, discount his advice, and maybe go for a second opinion? When faced with such dilemmas, most people trust their service providers to a very high degree and we are even more likely to trust them the longer we have known them. After all, if we have known our advisers for many years, wouldn’t they start caring about us more? Wouldn’t they see things from our perspective and give us better advice?

Another possibility, however, is that as the relationship extends and grows, our paid advisers—intentionally or not—become more comfortable recommending treatments that are in their own best interest. Janet Schwartz (the Tulane professor who, along with me, enjoyed dinner with the pharmaceutical reps), Mary Frances Luce (a professor at Duke University), and I tackled this question, sincerely hoping that as relationships between clients and service providers deepened, professionals would care more about their clients’ welfare and less about their own. What we found, however, was the opposite.