When it comes to helping patients manage chronic illnesses like diabetes or heart disease, friends and family may be more helpful than the family doctor — and they're a lot cheaper, too. That's the conclusion of analysts at the University of Pennsylvania's Center for Health Care Innovation. In an article in The New England Journal of Medicine, behavioral economists said leveraging existing social relationships can lead to new healthy habits and behaviors, such as improvements in diets and exercising. That's because friends and family members are around patients more than the doctors and nurses who manage their care and see them only occasionally. The researchers present a five-step ladder of social interactions that can influence healthy behaviors. At the bottom rung, patients are trying to manage their health condition alone, often with the least success. As one moves up the ladder, the degree of success increases with the levels of social interaction. At the top rung, there's mutual support between the patient and loved ones, with shared goals, leading to the most positive results. Social interactions, said researchers, are more likely to lead to healthful behaviors, such as steering a patient away from a sedentary activity, like watching television, to taking a walk or going to the gym. And they noted friends and family can more effectively suggest better choices at restaurants than a doctor telling a patient to watch his diet. 'Missed opportunity' Center director David Asch, who co-authored the article, called the benefits of these cost-free social interactions a "missed opportunity" that remains "largely untapped" by the medical community. He said concerns about privacy frequently get in the way of medical personnel's desire to rally the assistance of social connections. While Asch noted that privacy is important in some cases, patients with diabetes, for example, would "love" it if friends and family would help them manage their condition and get their health under control. The authors pointed to studies that have shown the benefits of social interactions in health care. For example, in one investigation, patients who talked on the phone weekly with a peer saw a more significant drop in a marker of diabetes, called glycated hemoglobin levels, than those who worked only with clinicians. "Sure, health care is serious business," wrote Asch. "But who says it can't be social?"