A Matter of Perspective: Choosing for Others Differs from Choosing for Yourself in Making Treatment Decisions

Many people display omission bias in medical decision making, accepting the risk of passive nonintervention rather than actively choosing interventions (such as vaccinations) that result in lower levels of risk. OBJECTIVE : Testing whether people's preferences for active interventions would increase when deciding for others versus for themselves. RESEARCH DESIGN : Survey participants imagined themselves in 1 of 4 roles: patient, physician treating a single patient, medical director creating treatment guidelines, or parent deciding for a child. All read 2 short scenarios about vaccinations for a deadly flu and treatments for a slow-growing cancer. PARTICIPANTS : Two thousand three hundred and ninety-nine people drawn from a demographically stratified internet sample. MEASURES : Chosen or recommended treatments. We also measured participants' emotional response to our task. RESULTS : Preferences for risk-reducing active treatments were significantly stronger for participants imagining themselves as medical professionals than for those imagining themselves as patients (vaccination: 73% [physician] & 63% [medical director] vs 48% [patient], P s<.001; chemotherapy: 68% & 68% vs 60%, P s<.012). Similar results were observed for the parental role (vaccination: 57% vs 48%, P =.003; chemotherapy: 72% vs 60%, P <.001). Reported emotional reactions were stronger in the responsible medical professional and parental roles yet were also independently associated with treatment choice, with higher scores associated with reduced omission tendencies (OR=1.15 for both regressions, P s<.01). CONCLUSIONS : Treatment preferences may be substantially influenced by a decision-making role. As certain roles appear to reinforce “big picture” thinking about difficult risk tradeoffs, physicians and patients should consider re-framing treatment decisions to gain new, and hopefully beneficial, perspectives.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72417/1/j.1525-1497.2006.00410.x.pd

Trends in Woody and Herbaceous Vegetation in the Savannas of West Africa

We assess 32 years of vegetation change in the West African Sudano-Sahelian region following the drought events of the 1970s and 1980s. Change in decadal mean rain use efficiency is used to diagnose trends in woody vegetation that is expected to respond more slowly to post-drought rainfall gains, while change in the slope of the productivity&ndash;rainfall relationship is used to infer changing herbaceous conditions between early and late periods of the time series. The linearity/non-linearity of the productivity&ndash;rainfall relationship and its impact on the interpretation of overall greening trends, and specific woody and herbaceous vegetation trends, is also examined. Our results show a mostly positive association between productivity and rainfall (69% of pixels), which can be best described as linear (32%) or saturating (37%). Choosing the &lsquo;best&rsquo; model at a specific location using Akaike Information Criterion has no discernible effect on the interpretation of overall greening or herbaceous trends, but does influence the detection of trends in woody vegetation. We conclude that widespread recovery in woody vegetation is responsible for the post-drought greening phenomenon reported elsewhere for the Sahel and Sudanian sub-regions. Meanwhile, trends in herbaceous vegetation are less pronounced, with no consistent indication towards either herbaceous degradation or recovery