EDITOR'S NOTE

By Ellen Engelhardt, PhD, Editor-In-Chief

As I write this final editor’s note, I’ve been reflecting on the experiences and insights gained during my tenure. Serving as editor has been a rewarding learning experience, and I’m very grateful to have had the opportunity to lead the newsletter.

I want to take this moment to thank our departing deputy editor, Dr. Aisha Langford, for her support and boundless enthusiasm. Brainstorming about the next Hot Topic and MDM poll with her was always a highlight. The dedication and expertise of the ADG team have been invaluable—thank you, Karina!

As I step down, I do so with confidence in the future of the newsletter. I am excited to welcome our new editor, Helen Colby, whose fresh perspectives and innovative ideas are certain to elevate the newsletter.

Finally, thank you for your continued engagement and support!

IN MEMORIAM

By Scott B. Cantor, PhD , SMDM Historian

On 27 March 2024, Daniel Kahneman died at the age of 90. He was an incredible influence on the field of medical decision making, in that he was a pioneer in the fields of behavioral economics and decision psychology. Even though he was trained as an economist, Kahneman was awarded the Nobel Prize in Economic Sciences in 2002. He was awarded the Decision Analysis Society’s Frank P. Ramsey Medal in 2006. Dr. Kahneman was the plenary speaker at the SMDM North American Meeting in 2002 – soon after he was awarded the Nobel Prize. His collaboration with Amos Tversky was documented in the popular book “The Undoing Project” by Michael Lewis. Kahneman and Tversky’s contributions on heuristics and biases in decision making and the model of prospect theory as an alternative to expected utility theory are well known to both normative and prescriptive decision scientists. Daniel Kahneman was a giant in the field of decision making uncertainty. He will be missed. 

By Alan Schwartz, PhD, President

Summertime is upon us in the Northern Hemisphere, and the last October annual meeting is coming up. The meeting chairs for Boston are organizing what should be an outstanding program, and as I write this message, hundreds of reviewers are reviewing hundreds of abstracts in preparation for it. Next year at this time, we’ll be holding our first June SMDM annual meeting in Ann Arbor, and planning is already underway.

I want to thank all of the members who participated in the recent strategic planning survey. There were many important suggestions that the Board will be considering and reporting on in the last half of 2024, but I’ll highlight three broad themes that appeared frequently in the responses.

First, members valued the Society’s meeting and journals highly, and offered several suggestions for making the meeting’s benefits more visible and accessible. Second, there was near-uniform acclaim for the Society’s educational programs outside the meeting, including webinars, short courses, and other work of our outstanding education committee. Third, many respondents suggested that SMDM would benefit from both more collaborations with other organizations and societies and from clarifying how its offerings are distinguishable from those other groups. You will be hearing more about the survey results and proposed goals and strategic activities in the future.

In other news, SMDM will be organizing a new comprehensive research handbook on medical decision making, to be published in 2026 by Edward Elgar Publishing. We will be forming an editorial committee and reaching out to members for chapter contributions. Finally, this will be the last newsletter issue where Ellen Engelhardt will serve as Editor and Aisha Langford will serve as Deputy Editor. I want to extend my personal thanks for their efforts in promoting communication within the Society. Helen Colby takes over for the next issue, and I look forward to her term eagerly.

Thank you all for your continued support of the Society! 

CROSSWORD FUN

By Ankur Pandya, PhD

Answers will be in the next issue of the SMDM E-Newsletter. If you cannot wait, request the answer sheet from info@SMDM.org and you will be sent a link to the answer sheet.

By Alan Schwartz, PhD, President

Reviewing my notes for the bar exam next month, I came across two examples of legal principles closely related to expected value that illustrate how U.S. courts have sometimes approached normative models of decision making as a matter of law. In 1947, in United States v. Carroll Towing, a barge carrying flour broke loose from a pier, collided with a tanker, and sank. The case involved questions of how much responsibility the barge shared with two different companies’ tugboats that were on the scene and might have prevented the sinking.

The storied judge Learned Hand famously wrote:

Since there are occasions when every vessel will break from her moorings, and since, if she does, she becomes a menace to those about her; the owner's duty, as in other similar situations, to provide against resulting injuries is a function of three variables: (1) The probability that she will break away;

(2) the gravity of the resulting injury, if she does;

(3) the burden of adequate precautions.

Possibly it serves to bring this notion into relief to state it in algebraic terms: if the probability be called P; the injury, L; and the burden, B; liability depends upon whether B is less than L multiplied by P: i.e., whether B > PL. 

United States v. Carroll Towing Co., 159 F.2d 169 (2d Cir. 1947)

Of course, SMDM members will recognize this as simple expression of the expected value of prevention.

The other principle, “loss of chance”, is even more closely tied to medical decisions, and arises in medical malpractice lawsuits. Traditionally, to prove that a doctor’s care was negligent in a wrongful death suit, the patients’ heirs would need to show that the patient’s death would not have happened without the substandard care. But what about a patient who has only a 30% chance of survival without treatment? If substandard care reduces the patient’s chance of survival to only 20%, so they are still more likely than not to die regardless, can they receive damages for the substandard care if they die? In Matsuyama v. Birnbaum (2008), the Supreme Judicial Court of Massachusetts determined that in cases like these the patient’s heirs were entitled to damages proportional to the reduction in the loss of chance of survival due to the physician’s action, e.g., 30% - 20% = 10% of the damages in this example. This kind of calculation has now been widely adopted in cases like these. But SMDMers may want to check out Robert J. Rhee’s 2013 paper Loss of Chance, Probabilistic Cause, and Damage Calculations: The Error in Matsuyama v. Birnbaum and the Majority Rule of Damages in Many Jurisdictions More Generally, in the Suffolk University Law Review Online, for a quasi-Bayesian argument that this calculation should also incorporate the overall likelihood of death, and not just the difference, and see if you agree.

By: Aisha Langford, PhD, Deputy Editor

In our last newsletter, we asked three questions about your experiences making decisions for others. Below is a high level summary of what you said and some example responses.

What is the hardest health-related decision you had to make for someone else?

Not surprisingly, many people reported that they had to make hard decisions for their parents and children. These decisions included withdrawal of life support and beginning hospice care. Other hard decisions centered around patients. Example answers included:

·       Decision about driving for 93-year-old mother after a small stroke.

·       Setting up a DNR [do-not-resuscitate] for parent with severe Alzheimer's.

·       Moving my father to a nursing home.

·       Ear surgery for my 4-year old daughter.

·       Decisions related to my son being born 3 months premature.

·       Whether or not to transfer a patient with end-stage dementia who could not swallow

and was becoming dehydrated to a hospital.

How, if at all, do we need to support parents, caregivers, and other surrogates differently with regard to MDM tools?

Example answers included:

·       Decision support acknowledging the 'cruel' reality and providing information on scenarios and possible (palliative) options.

·       I do not believe that different criteria should be applied depending on the relationship with the patient or that it is the patient themselves who requests advice.

·       Emotional, existential, spiritual, and religious components of decision-making should receive additional attention.

·       With the amount of Medicare plans for the elderly, the Part D plan is dynamic and changes during the year, which puts patients at risk for high drug costs. We need a tool that will inform patients on the most optimal plans that will reduce their costs and prepare them for potential shifts in the Part D formulary

Has your MDM knowledge helped or hindered you in your role as a surrogate decision maker?

Most members said that their MDM knowledge has helped them. However, not everyone felt that way:

·       A bit of both. It has helped to weigh options and set priorities (both for my elderly parents/in-laws and self), but I struggle with communicating with empathy and allowing myself to grieve. I also have become the go-to for friends and family on decision- making information/strategy; sometimes that help isn't appreciated.

·       Has not helped. The SMDM knowledge is too abstruse for use with family. Other family members who need to be part of the decisions do not understand or relate to the underlying assumptions, let alone the methods, of SMDM decision tools.

·       It has made me aware that I am not doing a great job, but unclear about how to do a better job.

Thank you for your time and participation. 

By Brian Zikmund-Fisher, PhD

Don't forget about MDM's Editors and Abstracts Hours!

MDM Journals Editor-in-Chief Brian Zikmund-Fisher and Deputy Editor Lauren Cipriano are continuing to host online Editors and Abstracts Hours, in which you can get 1:1 feedback on your paper ideas and abstracts. The next sessions will be on the following dates:



• Thursday 13 June 2024
• Thursday 18 July 2024
• Thursday 8 August 2024
• Thursday 12 September 2024
• Thursday 10 October 2024

Details and Zoom link information is always available on the MDM journals website. While reservations are not required, we always appreciate it if prospective authors let us know (mdm-journal@umich.edu) that you are planning to join us.

Please join us! Our goal is to answer questions about fit to the MDM journals and to provide constructive feedback, but mostly we love to chat. There is no cost or obligation, just an opportunity to talk with the editorial team.

We (Brian and Lauren) hope to see many of you soon!

INTEREST GROUP NEWS

By Davene R. Wright, PhD

The Decision Sciences for Child Health Collaborative [davenewright.com] (SMDM’s child health interest group) is recruiting new co-chairs. If you are interested in volunteering, please submit a maximum 300 word statement describing your interest in serving as co-chair, your relationships to the medical decision making and child health research communities, and your research interests by 15 July 2024. Please send questions and your statement to both Jody Lin at jody.lin@hsc.utah.edu and Davene Wright at davene_wright@hphci.harvard.edu.

SMDM EDUCATION