What is the point of spending billions on genetic tests, which warn patients of potential health conditions, if they pay no attention to the result? That is the question now being asked in countries like the UK, Denmark, Sweden, the Netherlands, Canada and Australia who, together, make up the most enthusiastic adherents thus far to evidence-based medicine.

A study in the UK has left many worried. Smoking is a known contributory factor to Crohn’s disease. So what happened when the relatives of Crohn’s patients were told that they had the relevant genetic weakness, and that they should therefore give up cigarettes? The answer, of course, was that their smoking cessation rate was no different than from the general public. This, despite close proximity to Crohn’s sufferers, and despite the greater probability of suffering the disease.

A larger test is now being carried out on middle-aged men with diabetes who have genetic weaknesses leaving them more likely to develop heart disease. If they, too, will not change their behaviour, then countries like the UK are unlikely to spend a fortune on testing the general population.

Meanwhile, it is clear that chronic disease management programmes are still not delivering major results. One of the largest and most lauded programmes in the UK was carried out by Birmingham Own Health, and the enthusiastic claims of its boss were reported by Healthcare Europa. The programme used a call centre of nurse mentors to encourage a range of chronically-ill patients to change their behaviour.

In 2011 Andrew Donald, Chief Operating Officer at NHS Birmingham East and North, claimed at the time that the group receiving the service saw hospital visits fall by half, with visits to family doctors down by 33%. He added: “We are committed to spending £10m on the programme by March 2012, but estimates are that we will get a return far greater than that. Work completed so far suggests anything up to £32m.”

But a detailed academic study published in August 2013 dismissed the claims. In fact, the patients on the programme were more, not less likely, to end up in hospital! Unsurprisingly, the programme has been ended.

These two studies highlight the central problem that all policymakers face. We still have no idea what steps payors can really take to make people change their behaviour.