Better Health through Better Decisions
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From the Editor

by Dana Alden, PhD, The University of Hawai`i
Hau’oli Makahiki Hou everyone!

Welcome to your Winter 2017 edition of the SMDM Newsletter. Our new President, Angie Fagerlin, opens this issue with a personal look into her SMDM journey from new member to President and a meaningful discussion of the many ways SMDM members are able to contribute to the Society.

In our Commentary section, we have several interesting articles that are well-worth reading. These include: former President Ahmed Bayoumi’s insights regarding the potential value and uses of patient group submissions to help inform medical decision making and research; Veerle M.H. Coupé, Henrica C.W. de Vet, and Ewout W. Steyerberg’s thoughtful discussion of the challenges and opportunities involved in developing decision support tools for providers in order to facilitate personalized treatment of cancer patients; Lauren Cipriano and Greg Zaric’s interesting and useful commentary concerning use of game theory as a tool for “designing and evaluating” policies that can positively influence health behavior; and Mark Liebow’s timely analysis of the implications of the November, 2016 national election for healthcare in general and medical decision making research in particular.  

Many thanks to our great contributors for their top notch Commentaries! We invite other SMDM members to consider writing a piece for our next Newsletter. The deadline for the Spring issue is March 13th. Please contact me ( or our Deputy Editor, Ellen Engelhardt (, if you’d like to discuss your Commentary idea.

Starting with the next newsletter, we are adding a regular contribution entitled, Interest Group Highlights.  This quarterly Commentary will focus on topics that reflect the IG’s focus and are of general interest to SMDM members. In addition, politics related to healthcare provision and research in the U.S. are likely to impact SMDM members to an even greater extent in the coming year. As a result, Mark Liebow has agreed to provide a quarterly commentary on the politics that affect our work. Thanks Mark! We welcome similar commentaries on the influence of politics on healthcare provision and research in other countries or regions.  

We look forward to including these features in our upcoming 2017 issues. Please let us know if there is anything else we can do to improve the usefulness and readability of your SMDM Newsletter.

Have a great 2017!   

Dana Alden, Editor

Why I Chose to Do More, by Angie Fagerlin 
How to Make Patient Group Submissions Meaningful, by Ahmed Bayoumi

Decision Support Tools in Metastatic Cancer, by Veerle M.H. Coupé, Henrica C.W. de Vet,  & Ewout W. Steyerberg

A Game We Should All Be Playing, by Lauren Cipriano & Greg Zaric

Call for Officers and Trustees
SMDM Award Nominations
What Are You Working On?
Member News
Graduating SMDM Members
Job Postings
Lifetime Contributors

38th North American Meeting Highlights
39th North American Meeting

Stay connected by taking advantage of these opportunities SMDM has to offer.
Join or Renew Your Membership
SMDM Connect
Opportunities to Network
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Editor in Chief
Dana Alden, PhD
The University of Hawai`i

Deputy Editor
Ellen G. Engelhardt, MA
VU University Medical Center, Amsterdam

From the President

by Angie Fagerlin, PhD, Chair of Population Health Sciences, Research Scientist, University of Utah, Salt Lake City VA Center for Informatics Decision Enhancement and Surveillance (IDEAS)

Why I Chose to Do More


Angie Fagerlin

I am sure many of you have read letters from SMDM presidents asking for increased volunteerism, increased donations to the society, and more overall involvement in SMDM. Upon reading these calls, your reaction might be to question why you should choose to do more…especially after you already may have spent a chunk of change in supporting the Society through membership dues and annual meeting registration.

I understand. I may have even had similar thoughts myself in the past. Yet, I have chosen to do much more with SMDM. I think it is important for you to know why … especially since you have entrusted me to be your President. So, let me start by telling you my story.

I was first introduced to SMDM by my mentor extraordinaire Peter Ubel. He brought me to SMDM for the 2000 conference, where I gave the worst talk I have ever given in my life (and let me tell you, I have given a number of awful talks). But, instead of being ignored, I was encouraged. The next year, the amazing people who volunteer to serve on the scientific committee allowed me to give a talk. Over time, the community that is SMDM enabled me to find my voice and to learn how to give a successful talk.

SMDM is also the place where I met and was influenced by the leaders of my field of shared decision making. People like Margaret Holmes-Rovner, Annette O’Connor (thank you one-on-one mentoring program organizers!), Deb Feldman-Stewart, Hillary Llewellyn-Thomas, Anne Stigglebout, Arthur Elstein and many more helped me grow. One of the things I always tell people considering attending their first SMDM meeting is that this conference provides you the opportunity to be able to talk with the people you have read for years—and that they actually want to talk to you too.

I have developed many of my research collaborations through introductions that occurred at SMDM annual meetings, some intentional and some accidental. Many of my achievements have been influenced and strengthened by the members of this society and the numerous opportunities provided by SMDM.

SMDM is also the place where I have built friendships and research collaborations with people from across the country and the world. It is the place where I spoke through tears when acknowledging the untimely death of our friend and colleague Seema Sonnad and where I have carried 3 babies on my hip while attending different events at multiple annual meetings—and have been supported in each instance.

It is for all these reasons why I have been volunteering at SMDM for over a decade and why I financially support the society.

Of course, each of us contribute in different ways at different times. When I had 3 very little kids, I did less. Now, I do more. I do so because SMDM isn’t just a society, it’s a community, perhaps even a family. I want SMDM to continue to be a place where junior people get to experience the advantages and strong mentorship that I did, even if those supportive relationships involve people at other institutions (because it is rare to be able to get all the mentorship you need from one person or one institution). I want SMDM to continue to be a place that facilitates all of the kinds of professional relationships that matter, whether senior-to-junior or peer-to-peer. The shared expertise you can receive and, more importantly, GIVE at SMDM can be content expertise, method expertise, expertise regarding work-life balance, or all of the above.  In my case, I place particular importance on mentoring women on academia issues, because believe it or not, there still lies shocking amount of sexism in academic settings.

So today I am asking for you to consider contributing to SMDM in the way you best can. Perhaps that is through mentoring someone, or maybe just reaching out to a peer and building a collaboration. Maybe it is through reviewing for our journals, running for office, volunteering on one of the strategic initiatives, joining a committee, or contributing financially. Maybe, if you can, it is through several of these.

SMDM is a volunteer organization run primarily by unpaid volunteers. For us to achieve our aims, we need as many people possible working together, coming together as a community. Thank you for considering!

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The opinions stated in the following commentary are solely those of the authors and do not reflect the opinions of the Society for Medical Decision Making.


How to Make Patient Group Submissions Meaningful

by Ahmed Bayoumi, Institute of Health Policy, Management and Evaluation, University of Toronto

I am a member of the Canadian Drug Expert Committee, a committee that makes recommendations to public insurers in Canada about which drugs should be listed on public drug formularies. As part of our decision making processes, we receive submissions from patient groups about individual drugs. I think lessons from the committee will be relevant for SMDM as we embark on the strategic plan objective to “Develop and promote our expertise in patient and public engagement in medical decision making.”

The patient groups’ submissions are often produced under strict time limits and have a relatively formal structure. They range from individual experiences to surveyed data. Recently, I was part of a symposium of patient groups and researchers who gathered to discuss several questions about such submissions – questions that I think are relevant for SMDM.

First, what are the objectives of having formal patient input into decisions? I think there are many, including: interpreting clinical data in patient-centered terms, providing important context to decisions that clinical and economic summaries do not communicate well, and raising additional concerns that are relevant to decision making – such as equity – that are not always rigorously considered when we focus on clinical evidence and cost-effectiveness. That’s an incomplete list. More important, perhaps, is the recognition that involving patient groups in decisions will, by definition, necessitate deeper thinking about what is important for making good decisions.

Second, how do we define rigor and quality when thinking about patient group submissions? This is perhaps the most challenging question of all. Who gets to speak for patients? Given the enormous challenges of representing a diversity of patient voices, is representativeness achievable or even desirable? Can we identify a new criterion – maybe we would call it “authenticity” – to indicate that the “voice” represented by the patient group submission is that of actual patients and not of other vested interests, such as pharmaceutical companies or clinicians? Can qualitative research approaches help us to address such issues?

Third, do patient inputs into decision making processes represent an additional form of “evidence” to be evaluated alongside clinical trials and economic analyses? Or are they forms of “advocacy” that have the potential to politicize the decision making processes? Is the distinction between advocacy and evidence a useful one? The large majority of the submissions our committee receives are from groups that have accepted industry support – and many groups have no other reliable funding source. Should we think about conflict of interest for patient groups the same way we think about conflict of interest for researchers?

It’s worth thinking about such questions when considering, for example, the EpiPen, which has increased in price by more than 500% in the US since 2007. The New York Times pointed out that the outcry over EpiPen prices came from patients, but not from organized patient groups. Rather individual patients used social media to find each other and organize to lobby for lower prices. Patient groups dedicated to advocating for patients and family members with severe allergies exist, but were largely silent when it came to the controversy, perhaps because they receive significant funding from the manufacturer? So which is the authentic patient voice?

There are many challenging questions related to engaging patients and the public more fully in decision making but also tremendous opportunities for SMDM. I look forward to many vigorous discussions.

Editor’s note: Please see for more information regarding funding of certain patient advocacy groups.

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The opinions stated in the following commentary are solely those of the authors and do not reflect the opinions of the Society for Medical Decision Making.

Decision Support Tools in Metastatic Cancer

by A/Prof dr. Veerle M.H. Coupé, Prof dr. Henrica C.W. de Vet, & Prof dr. Ewout W. Steyerberg

Cancer care is becoming highly complex. Following the increasing knowledge on the biological processes underlying tumor growth and proliferation, there are an increasingly large number of options to target treatment to the characteristics of the tumor of an individual patient. This holds especially for the metastatic phase of the disease, for which a large number of targeted treatments are expecting market access in 2017. Under these circumstances, treatment decisions are challenging and have to be taken under uncertainty.

To facilitate evidence-based care and personalized medicine, physicians increasingly express a need for predictive tools to support their decision-making. Such tools should inform on prognosis and expected benefits and harms for the individual patient under different treatment options (e.g. surgery or not, targeted therapy or not). Such models may be presented as nomograms or decision trees, and may be based on regression analysis or more advanced techniques such as support vector machines, Bayesian networks, or self-learning algorithms.

Prediction models may form the basis for a broader decision support tools, that is, web-based or mobile applications that integrate personalized predictions with, for example, information on different aspects of the disease or available diagnostics and treatments, an assessment of patient preferences, or self-help modules. Thus, decision support tools may be developed mainly as a support for the physician or may be partly or wholly dedicated to supporting shared decision making between physician and patient.

In the Netherlands, at present, a number of initiatives are ongoing that aim to develop decision support tools for personalized cancer care. One example is the collaborative project “My Best Treatment - Lung” between Maastro clinic, Tilburg University, Elizabeth-TweeSteden Hospital, Health Insurer CZ and the Decision Modeling Center VUmc. One of the objectives of the project is to combine the concept of shared decision making with the use of a decision support tool in lung cancer. The decision support tool aims to provide personalized predictions of survival, toxicity, and cost-effectiveness under different treatment strategies. This tool may be used and discussed in a shared decision making consult.

The development of clinically useful decision support tools is a challenging enterprise. A recent systematic review conducted by our group revealed that the available decision support tools for the incurable stage of lung cancer and colorectal cancer were generally of poor quality. Most were not sufficiently validated and included only a limited set of outcomes (usually only benefit in terms of survival but not treatment toxicity). Moreover, most tools did not predict outcomes under different treatment options, as was the case in the adjuvant setting (e.g., These tools are rarely used in the clinic. It seems that, thus far, decision support tools are mainly a scientific endeavor and do not yet meet their potential to support decision making in clinical practice.

What is needed to develop and maintain high-quality decision support tools that may truly assist physicians in decision-making? Most importantly, for development, but also for validation and updating, rigorous procedures should be followed. With respect to the latter, yearly updating of an existing tool may serve both to handle temporal changes, such as changes in case-mix over time, as well as reduce statistical uncertainty by continuously increasing sample size. In advanced cancer treatment, regular updating of tools is also essential to include the rapidly expanding number of treatment options available to physicians.

To reach this goal, a long-term effort is warranted, good quality data sources of sufficiently large sample size and collaboration between the relevant experts and stakeholders. In a Bayesian framework, scientific evidence from randomized controlled trials, well-designed prospective observational studies dedicated to the development or maintenance of prediction tools may be combined with large routine data collections such as data from cancer registries. With respect to the latter, the usefulness of registry data depends on the quality of available data records as well as on the level of detail concerning a range of (intermediate) outcomes and toxicities. To face the challenge, a truly interdisciplinary effort is warranted – an effort in which the expertise and knowledge are combined from clinicians, hospitals, experts in shared decision making and risk communication, epidemiologists, biostatisticians, and decision modelers.

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The opinions stated in the following commentary are solely those of the authors and do not reflect the opinions of the Society for Medical Decision Making.


A Game We Should All Be Playing

by Lauren Cipriano & Greg Zaric, Ivey Business School, Western University, London, Ontario, Canada

Many aspects of health care delivery and administration of medical and public health systems involve misaligned incentives. As a response, policies are often designed with the intention of modifying behavior by aligning incentives. Game theory is a mathematical tool that provides insights for designing and evaluating these policies.

Most people are familiar with game theory through the Prisoner’s Dilemma problem. In general, game theory provides a decision-making strategy which optimizes each player’s utility by choosing a strategy in anticipation of the actions of other players. Game theory identifies policy features that will be critical for success including solution properties that ensure willing participation and “incentive compatibility”. Game theory can also provide interesting insights into potential unintended consequences.

Common applications of game theory involve “principal-agent” models in which a principal (e.g., policy maker) designs a contract to optimize performance from an agent (e.g., provider or patient). These problems are challenging because the principal and the agent may have conflicting goals – for example, when the agent’s income is a cost to the principal. In addition, the parties may have different levels of information about some key parameter (called “asymmetric information”), and the actions of the agent might not be observable by the principal. Principal agent models in healthcare were made famous by Kenneth Arrow, Joseph Stiglitz, and others in their studies of competitive insurance markets. We illustrate with three examples of how principal agent models can be used to analyze modern problems of interest to the MDM community.

Example 1: Vaccination behavior. 

Vaccination of others in a community reduces the risk of infection for an unvaccinated member of the population for rare but potentially catastrophic illnesses. If each individual makes a purely self-interested decision about whether to vaccinate, vaccination rates will fall below levels necessary to keep the diseases rare. Without intervention, this would naturally lead to costly cycles (in both financial and human terms) of disease resurgence, resulting in increased vaccination rates which would cause a decline in the risk of disease from herd immunity leading to lower expected personal benefit and decreased vaccination rates. In order to tip the scales in favor of vaccination, some jurisdictions have made it difficult or inconvenient to opt out of vaccinations, and others have been more assertive by requiring vaccination for public school admission or receipt of state childcare and/or tax benefits.

Example 2: Pay-for-performance contracting for drugs.

Several jurisdictions have implemented pay-for-performance contracts for drugs. Examples include the contracts for bortezomib for multiple myeloma in the UK and sitagliptin for type 2 diabetes in the US. A simple model would be one where a payer offers a contract to a drug company setting a full price for a drug which is only paid if patients achieve specific health outcomes and an amount to be refunded when the health outcome is not achieved. The payer chooses contract terms to optimize an objective such as maximizing the expected total health benefits for a given budget. These contracts are particularly useful when there is substantial uncertainty about expected benefits or heterogeneity in patients.

Example 3: Bundled payments.

Many health care systems have started offering bundle payment systems at the physician and/or hospital level. In contrast to fee-for-service reimbursement systems, which incentivize providers to increase the number of services provided to each patient, bundled payment systems provide a fixed reimbursement level for a specific service (i.e., a total knee replacement surgery) and the provider’s profit increases when fewer services are provided.  For example, bundled payments may align providers to reduce waste (repeated testing), complications, length of stay, and re-admissions. Information asymmetry creates an opportunity for skimming lower-risk (more profitable) patients, which may reduce access to care for the most complex patients.

These examples only serve to introduce a tremendously flexible and useful framework for evaluating policies which intend to modify behavior through incentives and contracts. These contracts and schemes may influence direct treatment costs or downstream costs associated with outpatient care or readmission, unpaid caregiving needs, and health outcomes from reduced complications. Pay for performance contracts for drugs may encourage marketing practices that narrow the patient population to those most likely to respond (if predictors of response are known), but patient skimming may leave complex patients without access to care. Health economic modelers are particularly well suited to evaluate the intended and unintended lifetime and societal effects of patient or provider behavior change. We encourage members of the SMDM community to consider applications of game theory in their research.  

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The opinions stated in the following commentary are solely those of the authors and do not reflect the opinions of the Society for Medical Decision Making.

Trump Victory Brings Uncertainty to MDM Research Funding

by Mark Liebow, MD, MPH, Mayo Clinic

Donald Trump’s unexpected victory in November has made the future of medical decision making research uncertain. While Trump did not discuss most aspects of health policy in his campaign, he promised to “repeal and replace” the Affordable Care Act (ACA) and to block grant Medicaid. If the ACA is repealed, it will take the Patient-Centered Outcomes Research Institute (PCORI) down with it, as the institute was created in the ACA. Even if ACA funding is eliminated as a partial repeal through the budget reconciliation procedure, PCORI funding could be slashed or eliminated.

Republicans have long tried to eliminate the Agency for Healthcare Research and Quality (AHRQ) and might be able to do that. Some of AHRQ’s funding is from the PCORI tax that could go away with an ACA repeal and Congress could easily refuse to appropriate any new money for the agency.

While the National Institutes of Health (NIH) just received new money from the recently passed 21st Century Cures Act, its long-term funding may be threatened, since Trump wants to cut taxes and raise defense spending, which will put tremendous pressure on domestic discretionary spending, including NIH and other medical research funding, unless Republicans become more willing than in the past to permit high Federal deficits.

If the ACA is repealed and Medicaid is converted to a block grant program, many academic medical centers will be hurt financially. Given state budgetary issues, capping what the Federal government spends on Medicaid will slow the increase in or even reduce Medicaid spending over time. Repeal of the ACA will eliminate the Medicaid expansion. Since many urban academic medical centers are dependent on revenue from Medicaid patients, they may be much less able to pay for research out of clinical revenues.

Another Trump campaign promise, if made into law, would limit the ability of Muslims from certain countries to enter or stay in the U.S. This may, in turn, reduce the size of the medical decision making research professional and educational communities inside and outside of the U.S.

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38th Annual North American Meeting Highlights

Westin Bayshore, Vancouver, BC, Canada
October 23 - 26, 2016
From Uncertainty to Action

Over 500+ colleagues gathered to discuss medical decision making at the 38th Annual SMDM North American Meeting in Vancouver. With its theme, From Uncertainty to Action, participants gained greater understanding and connection with their colleagues in the field. Attendees were engaged and positive about their experience, with feedback describing the conference as "provocative," "so many great conversations and ideas,"  "wonderful," and a "great time networking and learning." Our Keynote, How to Make Medical Research Both Credible and Useful, by John P.A. Ioannidis, MD, DSc, Stanford University, was so thought-provoking that in New Zealand, #SMDM16 became a trending topic on Twitter for 20 hours! Read the full story here: 

Ever wonder what it would be like to attend a SMDM Annual Meeting? 
For a first person account, take a look at the attendees' highlights and biggest insights gathered from the Twitter hashtag #SMDM16 on Storify.

Each year, the Society encourages and recognizes outstanding work by young investigators. Trainee achievement is recognized by the presentation of the Lee B. Lusted Student Prizes for outstanding presentations of research. Congratulations to all of the awardees from this year's Annual Meeting (pictured below)!


Special Thanks also to our Meeting Chairs

Meeting Co-Chairs: Mark Helfand, MD, MPH and Nick Bansback, PhD
Scientific Review Commitee Co-Chairs: Laura Scherer, PhD and Feng Xie, PhD
Short Course Co-Chairs: Elisabeth Fenwick, PhD, MSc and David Whitehurst, PhD, MSc
Awards Commitee Chair: John Wong, MD
Lee B. Lusted Student Abstract Co-Chairs: Ankur Pandya, PhD and Eva Enns, MS
Career Development Committee Co-Chairs: Ava John-Baptiste, PhD and Fernando Alarid-Escudero, MSc
Women in SMDM Chair: Angie Fagerlin, PhD
Social Media Chair: Sarah Munro, PhD
International Networking Reception Chair: Anne Stiggelbout, PhD

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Mark you Calendar Now!
39th Annual North American Meeting 

Better Decisions Through Better Data Processes
October 22 - October 25, 2017
Pittsburgh, PA
Tweet: #SMDM17

Incremental gains in science are often made by standing on the shoulders of giants. Now that scientific advancement is increasingly dependent on complex data systems (the present-day giant), robust procedures are necessary to ensure that insights from data are not obscured from future scientists and real-time users. The Society for Medical Decision Making has a long history of developing methodologies which take advantage of complex data structures to enhance medical decision making and advance policy formation. The 2017 Annual Meeting will explore themes to ensure the credibility and usability of our Society’s efforts and to promote our vision of an integrated approach to health care decision making, through wise use and thoughtful communication of data.

Meeting Chairs

Meeting Co-Chairs: Ken Smith, MD, MS, FACP and Janel Hanmer, MD, PhD
Scientific Review Committee Co-Chairs: Victoria Shaffer, PhD and Feng Xie, MSc, PhD
Short Course Committee Co-Chairs: Hawre Jalal, PhD, MD and David Whitehurst, PhD, MSc

Exhibit & Sponsorship Opportunities

For more information:
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2017 Call for Officers and Trustees

The Nominations Committee of the Society for Medical Decision Making (SMDM) is soliciting nominations for the positions of:


Vice President–Elect
3 Trustees (including an International Trustee)

We invite SMDM members to submit the names of members whom you believe would serve the Society well. Self-nominations are encouraged. The Nominations Committee will consider all submitted names. At least 2 nominees will be selected for each position. Upon approval of the slate by the Board of Trustees, the list of nominees will be sent to all SMDM members. Additional nominees then will be accepted by petition, as described by the Society’s regulations.

Submit your nominations to Trevor Scholl at prior to 5:00 p.m. EST, February 24, 2017. Inclusion of information about the nominee’s past service to SMDM or other professional groups is helpful to the Nominations Committee’s deliberations. All nominations will remain confidential among the Nominations Committee until a slate is chosen.

Click here for more information on the selection process.

2017 Nominations Committee:
Mark Helfand, MD, MPH, Chair
Ahmed Bayoumi, MD, MSc
Beate Jahn, PhD
Miriam Kuppermann, PhD, MPH
Gillian Sanders, PhD

Pictured above: The 2016 SMDM Officers and Trustees gathered in Vancouver at the North American Annual Meeting. Please consider nominating yourself or a colleague to join the leadership of your Society.

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2017 Call for Award Nominations

Nominations are now open for SMDM's highest honors: 


Career Achievement Award

The Career Achievement Award recognizes a senior investigator who has made significant contributions to the field of medical decision making. The nominee need not be a member of SMDM. 

Eugene L. Saenger Award for Distinguished Service to SMDM

This award recognizes service to SMDM in terms of leadership, role in the operations of the Society, and contributions to the scientific and educational activities of the Society. The nominee must be a member of SMDM. 

John M. Eisenberg Award for Practical Application of Medical Decision Making Research

This award recognizes sustained leadership in translating medical decision making research into practice, including taking exceptional steps to communicate the principles and/or substantive findings of medical decision making research to policy makers, or clinical decision makers, or the general public. The nominee need not be a member of SMDM.

Outstanding Paper by a Young Investigator

This award was conceived as a means of recognizing outstanding work by a young researcher and assisting the recipient in the tenure process. The award is for a paper published, online or in print, in the calendar year prior to the award (journal must be published in 2016 for the 2017 award). The nominee must be in the first six (6) years of full-time employment after the end of “training” however that is defined within the country and field of the nominee.

For previous award winners and questions to stimulate thinking about worthy nominees please see:

Nominations must be received no later than 5:00 p.m. EST on Friday, February 24, 2017. A letter of support for your candidate and, if available, the nominee’s CV is recommended, but not required. Nominations should be submitted via email to Trevor Scholl at

The awards will be presented at the 2017 SMDM Annual Meeting in Pittsburgh, Pennsylvania.

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Interested in promoting your conference or job opening? Click here for more information. 


What Are You Working On?

Connect and collaborate with your fellow members on their latest projects:


Ethna McFerran, BSc Hons Nursing, Queen's University Belfast

My current work explores the effects of alternative testing strategies in the surveillance of persons after colorectal adenomatous polypectomy (CAP). As a PhD student from Queen's University in Belfast (N.Ireland) I am working in collaboration with Memorial Sloan Kettering Cancer Center and Erasmus MC. More broadly, my thesis work explores the ability to personalise recommendations for those living with the risk of colorectal cancer following CAP.

Nicholas Mitsakakis, MSc, PhD, P. Stat., University of Toronto

I am working on investigating and understanding the need of "independence" in multi-attribute preference based instruments. I am reviewing previously used definitions of independence applied on this topic, as well as formal statistical methods that have been applied for either ensuring presence of independence in instruments under development, or testing it using patient level data from existing instruments. Part of this work was presented in the recent annual meeting of SMDM in Vancouver, among other conferences. I am providing the link to my abstract below.


Mary Politi, PhD, Washington University in St Louis School of Medicine

Some of my recent work has focused on ways to support health insurance decisions among individuals making decisions in the ACA marketplace. Given the results of the recent presidential election, the ACA marketplace will likely change significantly. There is a lot of uncertainty about what the ACA and marketplace will look like. However, most policy scholars and the president-elect himself have described plans to maintain private insurance companies in a marketplace (whether within states or between states) rather than moving to a single-payer insurance system. Therefore, the importance of health insurance decision support is paramount to helping patients find insurance that best fits their needs. Choices might become even more complex if additional insurance carriers or plans are available to consumers across states. High quality health insurance decision tools should be able to account for any changes made to the choices available to consumers. Our current tool ( provides health insurance education, elicits preference ratings, and personalizes annual out of pocket cost estimates for consumers based on population level data estimating health care utilization by age, gender, and health condition(s). We have modified our algorithm and personalized cost calculation from 2015-2016-2017 when plan choice and costs varied (many plans were not available year to year; new plans emerged year to year). We will continue to alter our algorithmic prediction of costs due to expected changes in subsidy eligibility or cost-sharing reductions that the government currently provides for low-income consumers. If anyone would like to collaborate on ways to support health insurance choices, especially given the likely change in the health insurance landscape, please let me know. I look forward to working together to help consumers find insurance plans that meet their needs so they can access needed care.

Supporting information:
Development paper published in BMC Health Services Research:

Evaluation paper published in MDM P&P:

We Want to Hear from You!
This section of the Newsletter invites you to describe current projects that are either in the formative stage or underway. The idea is to enable all of us to learn more about the ongoing activities of our Society and to potentially connect members with like interests on a regular basis! Please consider submitting news about projects in the idea stage as well as those that are ongoing to this section, and if you are looking for collaborators or advice in a specialized area, don’t hesitate to include that information in your submission. 

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Members in the News

The latest news from your fellow members:

Jessica S. Ancker, MPH, PhD, published an article demonstrating that changing the default options in an electronic health record more than tripled the rate at which physicians prescribed generic drugs. Generics are cheaper for patients, and the lower co-pay generally means patients are more likely to take their medicines as prescribed. The research won the best abstract award at the SMDM conference in Phoenix, AZ, in October 2012. The article, "Effects of an e-prescribing redesign on rates of generic drug prescribing: Exploiting default options," by Sameer Malhotra et al., was published in the Journal of the American Medical Informatics Association (JAMIA) in 2016.

Paul F. M. Krabbe, PhD, University of Groningen, University Medical Center Groningen, recently published The Measurement of Health and Health Status: Concepts, Methods and Applications from a Multidisciplinary Perspective. Krabbe reports: After working for almost 25 years on the evaluation of health interventions in the setting of university hospitals, I realized that the field of health outcomes measurement is partitioned off in segregated areas. This is particularly evident with respect to subjective phenomena such as perceived health status or (health-related) quality of life. Some of those who investigate or apply the instruments adhere to the framework of psychometrics; others call themselves clinimetricians and use different concepts and methods; another group consists of health economists and decision-science researchers who have their own framework. Most of them are unfamiliar with other frameworks and often not even aware of what these can offer. There is widespread misunderstanding of the different approaches to conceptualize and measure health and health status. My goal with this new book is to bring these frameworks together, as they are far more closely connected than generally recognized.

Nicholas Mitsakakis, MSc, PhD, University of Toronto, has recently received the accreditation of Professional Statistician (P.Stat.) from the Statistical Society of Canada (SSC). This accreditation is granted based on a combination of formal education in statistics, relevant practical experience, and a demonstration of ethical professional competence.

Joe Pliskin, PhD, formally retired from Ben-Gurion University of the Negev in Israel. He continues to be on the faculty of the Harvard School of Public Health and is open to other possibilities of teaching and research. Especially interested in executive programs and international programs.

Lois Snyder Sulmasy, JD, Center for Ethics and Professionalism, American College of Physicians, recently published the article, "On Being a 21st Century Patient" in the Annals of Internal Medicine. on February 2, 2016.

Krishna Reddy, MD, Massachusetts General Hospital, recently performed a study published in The Journal of Infectious Diseases with colleagues Rochelle P. Walensky, MD, MPH, Massachusetts General Hospital, A. David Paltiel, MBA, PhD, Yale School of Public Health, Milton C. Weinstein, PhD, Harvard T.H. Chan School of Public Health, Robert A. Parker, ScD, Massachusetts General Hospital Elena Losina, PhD, Brigham and Women's Hospital, Travis P. Baggett, MD, MPH, Massachusetts General Hospital, Nancy A. Rigotti, MD, Massachusetts General Hospital, and Kenneth A. Freedberg, MD, MSc, Massachusetts General Hospital.

The team used a simulation model to demonstrate that among people living with HIV in the US who are on treatment, smoking reduces their life expectancy by twice as much as HIV. People with HIV who are on treatment but smoke, are much more likely to die from smoking than from HIV. Results from the study were featured on NBC News along with the graphic below. For more information, please see

A chart of the yearly number of mutations produced in a given type of cell by smoking a pack of cigarettes a day. Source: Genome Research Limited 

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Student News

Congratulations to our upcoming graduates:


Ilona Fridman
Degree / Graduation Date: 
PhD, Spring 2017
Area: Decision Making, Healthcare, Ethics of Influence and Persuasion
Position Seeking: Post-doc

Dissertation: When Advising a Negative Option, De-intensifying Negative Reactions with a Non-Fit Message Can Help
Advisor: E.Tory Higgins


Ying Lin, PhD
Degree / Graduation Date: 
PhD, 05/01/2017
Area: data analytics, operations research, medical decision making
Position Seeking: academic, post-doc

Dissertation: Large-scale Personalized Health Surveillance by Collaborative Modeling and Selective Sensing
Advisor: Dr.Shan Liu, Dr. Shuai Huang

Presented at Annual Meeting: (1) “Adaptive Monitoring of Depression Patient Population: A Selective Sensing Approach”, SMDM 38th Annual Meeting, Vancouver, CA, Oct. 2016. (2) “A Longitudinal Pattern based Prognostic Model for Depression Monitoring via Rule-based Method”, SMDM 38th Annual Meeting, Vancouver, CA, Oct. 2016.


Ethna McFerran, BSc Hons Nursing, Queen's University Belfast
Degree / Graduation Date: PhD, 2018
Area: Health Economics

Short Courses Attended: (Session: AM04) Decision Modeling (Session: PM08) Sensitivity Analysis and Value of Information Analysis Using Regression MetaModeling


Brittany Speller
Degree / Graduation Date: Master of Science, 11/1/2017
Area: Health Services Research
Position Seeking: Non-profit research or academic
Advisor: Dr. Nancy Baxter


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 Job Postings

Here are the most recent job postings since our last newsletter. Stay up on the newest opportunities in the Resource Section of SMDM Connect


Assistant/Associate Professor, Dept. of Biomedical Informatics, University of Cincinnati

NYU Langone Medical Center Project Manager

Postdoctoral Fellowships in Bioethics and/or Decision Sciences at the University of Michigan

Open Rank Faculty Position - Epidemiology, Indiana University, Richard M. Fairbanks School of Public Health

University of Michigan - Open Rank Faculty Position Child Health Evaluation and Research (CHEAR) Center

Scientific Director/Faculty University of Pittsburgh Graduate School of Public Health

K12 Scholar in Decision Science - Brown University School of Public Health

Assistant or Associate Professor, Center for Health Economics of Treatment Interventions for Substance Use Disorder, HCV, and HIV

University of Michigan Department of Health Management and Policy Tenure Track Faculty Position

Open Rank Faculty Position in Communication and Health - Northwestern University

Tufts University Medical School: Assistant or Associate Professor of Public Health & Community Medicine

HSR faculty position at The University of Texas MD Anderson Cancer Center

VCU - Non-Tenure Track Instructor in the Fuemmeler Lab

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SMDM Lifetime Contributors

SMDM extends its heartfelt appreciation to members for their charitable contributions!


We are very pleased to announce that 71% of 2016 board members and 61% of former board members have made charitable contributions to support our Society!

* Indicates a board member who served in 2016
+ Indicates a former board member


A very special thank you to the following people for making annual contributions each year over the last five years!

* Ahmed Bayoumi
* Alan Schwartz
* Brian Zikmund-Fisher
+ Bruce Schackman
* Dana Alden
+ Dennis Fryback
Jill Metcalf
Joseph King
+ Neal Dawson
Peder Halvorsen
+ Scott Cantor & Lisa Stone


Special recognition of our largest individual donors in 2016!

* Angela Fagerlin
+ Bruce Schackman
* Dana Alden
George Torrance
+ John Clarke
Joseph King
* Mark Helfand
+ Sankey Williams


Congratulations to those who moved up a level of giving in 2016!

* Angela Fagerlin
Arna Dresser
Donald Brand
+ Elizabeth Fenwick
Ewout Steyerberg
George Torrance
Jag Chhatwal
+ Kathy McDonald
+ Mark Roberts
Michael Hagen
Michael Rothberg
+ Milton Weinstein
+ Robert Hamm
* Scott LaJoie


Welcome to those who donated to SMDM for the first time in 2016!

+ Alvin Mushlin
Andrew Davies
Andrew Hathaway
+ Beate Sander
Bin Wu
Cara McDermott
Christopher Parker
Davene Wright
Dena Cox
Elissa Ozanne
* Ellen Lipstein
Gregory Aarons
Howard Weeks
+ Ida Sim
Jamie Studts
Jeffrey Hoch
Jeffrey Johnson
Kenneth Smith
Michael Rubin
Rob Boer
Scott Grosse
Sharon Straus 


Thank you to charitable foundations for their support in 2016!

Hess Foundation, Inc.
Stahl Family Bioethics Foundation in honor of Dr. Eva Bamberger Stahl


We extend our sincerest appreciation to everyone who has supported SMDM over the years!

Donations, including in-kind donations, received Oct. 2005 – December 31, 2016.
Bolded individuals made contributions in 2016.
Italicized individuals moved up a level of giving in 2016.

Raiffa-Kahneman Circle 

(Contributions total $5,000 or more)
* James Stahl (‘06, ‘09, '10, '12, '15, '16)
+ Jeremy Goldhaber-Fiebert ('13, '14)
+ John Clarke ('13, '14, '16)
Joseph King (‘06 - '16)
* Mark Helfand (‘05, ‘07, '10, '11, '16)
+ Michael Kattan ('13 -'16)

Pareto Level

(Contributions total $1,000 - $4,999)
* Ahmed Bayoumi (‘06, '08-‘16)
* Angela Fagerlin ('14-'16)
+ Bruce Schackman (‘06-'16)
* Dana Alden ('12-'16)

+ David Rovner &
Margaret Holmes-Rovner (‘05-'15)
+ Dennis Fryback (‘05 -'16)
+ Frank Sonnenberg (‘06, ‘09)
George Torrance (‘05, '16)
+ Harold and Carol Sox ('10 - '15)
Jill Metcalf (‘07 - '16)
+ John Wong (‘06 - '13, '16)
+ Marilyn Schapira (‘07 - '12, '14-'16)
+ Mark Roberts (‘08, ‘09, '13, '15-'16)
+ Michael Barry (‘06 - '10, '16)
+ Murray Krahn ('13, '14, '16)
+ Sankey Williams (‘06 - ‘08, '13, '14-'16)

* Uwe Siebert ('11, '13, '14)
William Lawrence (‘06, '10, '11, '13, '15, '16)

Edwards Level

(Contributions total $750 - $999)
+ David Meltzer ('07, '09)
Donald Brand ('13 - '16)
+ Joel Tsevat (‘06, ‘09, '10)
+ Kathryn McDonald (‘07, '09, '10, '14-'16)
+ Neal Dawson (‘05 - '16)
Peder Halvorsen ('11 - '16)

Sara Knight (‘05 - '15)
+ Scott Cantor & Lisa Stone (‘07 - '16)
+ Seema Sonnad (‘06, ‘07, ‘09, '12 - '14)
+ Stephen Pauker (‘06, ‘09)

Tversky Level

(Contributions total $500 - $749)
* Alan Schwartz (‘07, '10 - '16)
+ Anirban Basu ('13)
+ David Paltiel ('07, '09)
+ David Sugano (‘07, ‘09 - '11, '13)
Jef van den Ende ('10, '14)
Jeffrey Johnson ('16)
Kate Christensen (‘09)
+ Myriam Hunink (‘05 - '14-'16)
+ Nananda Col (‘05 - ‘09)
* Robert Beck (‘07)
Steven Kymes (‘05 - ‘09, '12, '15-'16)

von Neumann-Morgenstern Level

(Contributions total $250 - $499)
+ Amber Barnato (‘05, ‘07, '11, '12, '14)
Andy Briggs ('14)
+ Arthur Elstein (‘06, ‘07, ‘09, '10, '16)
+ Dena Bravata (‘06, ‘09, '10, '11)
Don Husereau ('13)
+ Elena Elkin (‘07, '14)
* Heather Taffet Gold (‘08, '11, '14-'16)
Jag Chhatwal ('15-'16)
Jeffrey Hoch ('16)
+ Karen Kuntz (‘09, '11)
+ Liz Fenwick ('14-'16)
+ Mark Eckman (’06, ‘09)
* Miriam Kuppermann (‘06 -'10, '12, '14-'16)
+ Randall Cebul (‘06, ‘08, '10)
+ Robert Hamm (‘06, ‘08, '14, '16)
+ Robert Wigton ('10, '11, '14)
Sharon Straus ('16)
+ Thomas Tape ('10, '11, '14)

Markov Level

(Contributions total $100 - $249)
+ Alan Garber ('10)
+ Allison Rosen (‘07)
+ Alvin Mushlin ('16)
Andrew Davies ('16)
* Andrew Scott LaJoie ('10, '16)
Arna Dresser ('10, 12, '14, '16)

* Beate Sander ('16)

Benjavan Upatising ('13)
Brian Rittenhouse (‘07)
* Brian Zikmund-Fisher (‘08-'16)
Cara McDermott ('16)

+ Cathy Bradley (‘07)
Christopher Parker ('16)
+ Curtis Langlotz ('12)
Elamin Elbasha ('16)
* Ellen Lipstein ('16)

Esther Kaufmann ('11)
Ewout Steyerberg (‘06, ‘09, '11, '13, '16)
Gregory Aarons ('16)
Howard Weeks ('16)

Jesse D. Ortendahl ('11, '12, '13)
Joanne Sutherland (‘08, ‘09)
John Thornbury (‘05)
Joseph Johnston ('15)
Joseph Ladapo ('12-'15)
Kenneth Smith ('16)
Linda Canty ('12)
Lisa Maillart ('10)
Magdelena Flatscher-Thöni ('14)
+ Mary Politi ('14-'16)
Michael Hagen ('10, '16)
Michael Rothberg (‘09-'12, '16)

Michael Rubin ('16)
+ Milton Weinstein (‘09, '11, '16)

* Natasha Stout ('14-'16)
Paal Joranger (‘14)
+ Peter Neumann ('14-'15)
+ Phaedra Corso (‘06, ‘07, ‘08)
Richard Orr (‘05, ‘06)
+ Roy Poses ('14)
+ Scott Braithwaite (’09)
Sun-Young Kim (‘07, ‘08, ‘10, '13)
Ursula Rochau ('14)
Verena Stühlinger ('14)

Bayes Level

(Contributions total up to $100)
Amit Gupta (‘06)
Andreas Maetzel (‘09)
Andrew Hathaway ('16)
+ Anne Stiggelbout (‘06)
April Kimmel ('14)
Bin Wu ('16)
Carmel Crock (‘09)
Carol Stockman (‘05)
+ Cindy Bryce ('14)
Clara Lee ('15)
Daniel Masica (‘08)
Danielle Timmermans (‘07)
Davene Wright ('16)
David Howard (‘09)
+ David Katz (’08)
Dena Cox ('16)
Denise Bijlenga (‘08)
Elissa Ozanne ('16)
Eran Bendavid ('11)
Erika Waters ('14)
Evan Myers ('12)
Eve Wittenberg ('14)
George Papadopoulos (‘08)
+ Gillian Sanders (‘07)
* Hilary Bekker ('12)
Holly Witteman ('14, '16)
Hugues Vaillancourt ('11)
+ Ida Sim ('16)
Ivar Sonbo Kristiansen ('10)
+ James Dolan (‘09)
Jamie Studts ('16)
Jane Pai ('10)
Jessica Ancker ('14)
Jha Saurabh (‘09)
Job Kievit (‘09)
Karen Sepucha ('14)
Kerry Kilbridge (‘05, ‘07, ‘08)
Kimberly Blake (‘09)
Kristin Hendrix ('14)
Lee Green (‘07, ‘09)
* Lisa Prosser (‘08)
Negin Hajizadeh ('14)
Rob Boer ('16)
Robert Werner (‘08)
Rohan D'Sousa ('15)
Rowland Chang (‘06, ‘07)
Sarah Hawley ('14)
Sarah Kobrin ('14)
Sarah Lillie ('14 - '15)
Scott Grosse ('16)
Tanya Bentley ('14)
+ Ted Ganiats (‘05)
Theodore Yuo ('15)
Thomas B. Newman ('10)
Thomas Trikalinos ('15)
Valeria Reyna ('14)

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