• Framing Bias and More Information





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    • We need decision aids

    • @Eric
      we also need to start identifying scenarios in which we don’t provide certain types of care as a matter of course

    • I occasionally tell med students that medicine is the art of applying large scale population statistics to individual patients. Sometimes, it is pretty difficult to know what one should do. Still, we need to get past the idea of doing stuff just because we can. We need a better sense of value for the care that we offer.


    • I have some background in statistics and understand that the absolute mortality risk reduction of 2% is far more meaningful than the one-third reduction. The latter is a much more powerful statement, however, and I couldn’t say with any certainty that it wouldn’t influence my decision. Similarly, a 50% reduction in mortality from 2 in 10,000 (for treatment A) to 1 in 10,000 (for Treatment B) sounds so much more meaningful than it is. Saying that taking treatment B doubles my chances of dying would be an even more powerful, if equally meaningless statement.

    • @ George
      I agree it is hard to understand and communicate. I think one of the hardest things for us culturally to get is that the probability of death in 100%. This means that all the things we do to forestall the inevitable eventually stop working. Doesn’t mean we should try, it just means we should expect to be looking for signals that doing more won’t work.

      • I agree that it’s not just a communication issue. Valuing life is and should always be a core principle of our society, but any principle can be pushed to extremes. Despite the potential for setting a record for sophistry, hysteria, and political cheap shots, a national discussion of what medical necessity means for publicly funded programs is badly overdue. What people do with their own money is their business, but elected officials have a duty to decide how small a chance of extending someone’s life and how short an extension tens if not hundreds of thousands of tax payers dollars should be spent per patient to pay for.. I

        Once that decision is made, the question of whether something is medically necessary, whether it meets that criteria becomes a scientific question.

        • @George
          we have to figure out how to make such a discussion an expectation and not such a hot button political topic. I think this is a case where the politicians are mostly responding to the incentives provided by the culture.