The "Breaking Bad" Effect: Cancer Diagnoses Can Prompt A 14 Percent Increase In Criminal Convictions

Verone probably didn’t strike anyone as being the bank robbing “type”. He had no prior criminal history, and he apparently even felt guilty that his “robbery” caused the bank teller any distress. Despite how mild-mannered this whole robbery may seem, for Verone, it was very much justified.

Three years before his arrest, he lost his job of 17 years as a Coca-Cola delivery man, and despite his efforts to secure steady work, his situation became increasingly desperate: he had developed chronic back pain, a limp in his left foot, and he had a lump on his chest. But without medical insurance, he had no way to get them treated by the doctors. So, for Verone, a desperate situation called for desperate action. He didn’t rob the bank to pay for that treatment; he robbed it in the hope that, by being arrested, he would receive adequate healthcare.

This may be considered a slightly humorous example, but it does highlight a theme that was already becoming famous across the United States and other parts of the world, albeit in a more dramatic way. In 2008, HBO launched the first series of Breaking Bad, a story about a mild-mannered chemistry teacher who turns to a life of crime after receiving a terminal cancer diagnosis. Walter White, the series’ antihero, quickly becomes disillusioned with his life after the diagnosis and decides to use his chemistry skills to make drugs so he can accrue as much money as possible for his family.

The story has become a cornerstone of modern TV, landing dozens of awards during its run. But as we can see from Verone’s case above, Walter White is not the only person to have decided to take drastic action after receiving a sudden health shock.

As I am sure many people are aware, not everyone who receives a negative medical diagnosis goes on to commit crimes. But, as new research demonstrates, the number is actually much higher than you might expect. According to the study, people are significantly more likely to be convicted of a crime in the years following a cancer diagnosis.

So, what’s going on here?

An age-old problem

What causes someone to commit a crime? The topic is huge and has been studied by curious individuals for centuries, so the answer you’ll get will ultimately depend on the person you speak to. Philosophers, historians, psychologists, sociologists, anthropologists, neuroscientists, and economists all have their perspectives, many of which overlap and develop from one another. 

For instance, psychologists may focus on an individual’s behavior and what motivated them to commit a crime. They may look at things such as impulsivity, self-control, a person’s ability to control their emotions, or their desire to seek sensations. Alternatively, they may look at developmental conditions related to person’s childhood or early experiences. Did they experience neglect or abuse, were they exposed to violence in the past, and how did parental behavior influence them?

In contrast, a sociologist may look for broader social patterns, exploring how crime can arise when people cannot achieve socially valued goals – e.g. acquiring wealth or status – through legitimate means (known as the strain theory). Or they may look at specific communities to see where crime occurs and how it relates to factors such as poverty, high unemployment or weak community institutions (the social disorganization theory), to see if community breakdown leads to a loss of social control.

For economists, the subject of crime can be explored by way of incentives and constraints. For instance, in 1968, Gary S. Becker suggested that criminal behavior can be understood as a rational decision. For Becker, potential perpetrators weighed up the expected benefits or costs of a crime, against factors such as the probability of being caught and the severity of the punishment. This was quite a big development for criminology. Prior to this, dominant theories held that criminals were biologically or mentally deviant in some way, but this economic approach suggested criminals were ordinary people with the same general motivations as others. 

Expanding on Becker’s work, Isaac Ehrlich, an American economist, shifted the perspective to conceptualize offending as a choice of how someone decides to allocate their total available time. This meant he saw individuals as dividing their time between legal and illegal activities based on expected returns. In this context, if legitimate wages rise, the opportunity costs of crimes increase too – so crime rates should, by this reasoning, drop. If the probability of being apprehended for a crime or the severity of the punishment rises, then the crime’s expected payoff may decline too.

Although these theories had significant limitations – e.g. crimes are not necessarily calculated activities – they are still considered foundational explanations for crime that continues to shape law and economics research. In particular, they predict that the decision to commit a crime depends on various factors that include the costs or benefits of legal or illegal activities, potential punishments, and a person’s attitude towards risk. So, they are a good basis to test the extent to which health shocks can influence perceived incentives and constraints.

Breaking bad

When it comes to data, Denmark is quite a useful place for research as information gathered here can easily be linked across different governmental siloes. It was while experimenting with this data that Kim Peijnenburg, Full Professor of Household Finance at Tilburg University, noticed something interesting.

I was just looking at some summary statistics to see if you can see people ‘breaking bad’, and you can.

Kim Peijnenburg

“I watched Breaking Bad, and really enjoyed that show,” Peijnenburg told IFLScience. “I was also working with administrative data from Denmark, and honestly, I was just browsing it when I saw that there’s this unique combination of being able to match crime data with health data, as well as other variables of interest. I was just looking at some summary statistics to see if you can see people ‘breaking bad’, and you can.”

After this initial insight, Peijnenburg joined forces with other economists to dive into the data in more detail. Rather than considering all possible health shocks, the team focused on cancer diagnoses. This was because cancer is widespread in the population – around 40 percent of people will develop cancer during their lives – and it affects people of all ages, genders, and social backgrounds. Receiving a cancer diagnosis is also a very serious moment for a person, so it can have a more profound impact on how they behave.

Cancer also tends to impact people’s physical condition to a lesser extent than other serious medical conditions, such as strokes, in the medium to long run. As such, a cancer diagnosis is less likely to prevent someone from being able to commit a crime.

The team analyzed data covering the entire Danish population and containing demographic, labor, education, income, wealth, health, and crime information. They focused on 368,317 individuals who received a cancer diagnosis between 1980 and 2018, and by linking health records with criminal data, they were able to track individuals’ behavior against a control group of people who had not received a diagnosis.

The data showed that, in the first year following a cancer diagnosis, crime rates actually decreased. This, the researchers believe, is likely because the patients are receiving intensive therapies, such as chemo- or radiation therapy.

But then after two years, the situation changes; patients become more likely to receive a criminal conviction compared to their pre-diagnosis baseline. This rise is not small either – it’s statistically significant and continues to increase for five years after they receive their cancer diagnosis. After this, the effect stabilizes at this level for another five years.

“What happens is that people get sick, they get treatment, and they're less able to commit crimes,” Peijnenburg said. “They need to be in relatively better health first. So, in the beginning you actually see a drop in a propensity for crime, and then there’s a persistent high effect that starts after two years.”

The research ultimately showed that, following a cancer diagnosis, the probability that patients will commit a crime increases by around 14 percent. And this is not just people with previous convictions either. The cancer diagnosis seems to lead people with clean records to become offenders for the first time. But why was this happening?

Unlike the USA where the Breaking Bad series is set, Denmark has universal healthcare. As such, the patients were not faced with high unpaid medical bills which may have contributed to their decision to commit a crime. However, that does not mean economic factors did not play a role. Following a cancer diagnosis, the probability of employment for patients falls by 1.5 percentage points. At the same time, those who retain a job will likely work fewer hours, which will impact their overall income.

“We show that the individuals who have the strongest crime-cancer relation also tend to experience the largest decline in total income,” the team write in their paper.

“It is evident that the groups that experience the strongest effects on their income are more likely to commit crimes after cancer, suggesting that individuals whose human capital is affected the most seek additional revenues from the illegal labor market.”

Those who lacked financial buffers, such as a spouse or home equity, were also the most likely to go on to break the law.

Another factor the team explored related to a darker subject: survival probability. Health shocks can shorten a person’s life expectancy, which, so the theory goes, could skew their perception of potential future consequences. To investigate whether this was the case, the researchers divided patients into subsets based on an assessment of how much life they were likely to have lost due to their cancer.

The results showed that the link between cancer and criminality was highest among those whose survival probability was most impacted by their diagnosis. The evidence suggests that cancer patients face lower expected cost of punishment due to a lower survival probability.

This would explain why the rise in the types of crimes cancer patients were involved in were not limited to financial ones but included violent offences too. If you’re not likely to be alive to serve a long prison sentence in the next five years, then your view of the risks associated with a crime may drop off entirely.

So, if these increases are consistent and persistent, is there a way to mitigate them? In 2007, reforms put a cap on how much welfare support Danish municipalities could offer people, forcing some to become less generous than others. The study found that the municipalities that cut welfare support (“stingy municipalities”) experienced an increase in health-shock related crimes. This result shifts out perception of welfare programs from just being support mechanisms. Instead, they serve as a valuable public safety system that actually mitigates negative effects on society.

“An adequate welfare system appears to play an important role in this context,” the team conclude.

“Our results indicate that policies that address the economic consequences of health shocks are important in mitigating the resulting impact on crime.”

The study is published in the American Economic Journal: Applied Economics.