As a first clue, there is some hypocrisy. Your average intellectually capabple person of class would regard these mailings as suspect and the coupons as cynically manipulative. Timely news ("The drug you are taking comes off poorly in this or that study") might be of some value but many would balk at the anonymous, statistical, financially-oriented attempt to manipulate one’s health care (if we had a choice).

Second: effecting behavior change of this sort is health care. One should hold an effort like this to the same standards of responsibility one would hold a physician. "Try this drug instead, you might like it", coupled to financial incentives which to many may as well be coercion, absent direct examination and monitoring of the patient — surely this is not consistent with "First of all, do no harm."

Third, in attempting to effect mass behaviorial change, one must ask what hill this effort will climb, if it succeeds. For example, how is the decision to pimp Prilosec arrived at and what alternative decisions are simply not on the table? Would it ever occur to this company to, say, offer coupons for healthier food, for the local YMCA, or just flat out give away cash?

How about this reform: the company thinks it knows how to use statistics to generally improve the health of a population, do no harm, and save money for all those at financial risk in the health care system. They key to this is behavioral change. Ok, if they want me to participate as an individual health care recipient (assuming I had health insurance, hah) — how about they pass on some of the savings to me in the form of cold cash in exchange for information and selective participation — along with careful measurements to make sure their "free (or better) advice" is at least not making my health any worse?

In fact, let’s go one better. Since such a major source of expense for the health care system, impacting all who are financial liable along the entire pipeline, is that people without insurance tend to fall-back on emergency rooms — how about expanding the service (with my suggested reforms) to include the uninsured? In exchange for a willingness to undergo means testing, perhaps companies like this can help to mediate privately funded, charitably distributed health care with a heavy emphasis on prevention and lifestyle improvement. Let’s get our best and most respectable bang for the buck, no? (yes, welfare systems, whether private or public, also raise the question of "What hill are we climbing?" but at least we can contemplate the simpler approach I’m taking and its potential ancillary contributions to an overall increase in social interconnectedness and decrease in poverty)

-t