Better Health through Better Decisions
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From the Editor

by Dana Alden, PhD
Summer time … long days with lots of sunlight (unless you’re south of the equator ☺) and hopefully more time to sit back, pour some tropical (of course!) ice tea, and enjoy your Summer 2016 SMDM Newsletter! It’s a good one!

Our President, Mark Helfand, starts things off with an invitation to contact him about possible roles that SMDM as an organization or our members as individuals can play in the development of “value frameworks” that provide drug therapy pricing guidance to US HTAs and other payers. Mark’s letter is both informative and interesting with links to valuable information for those who want to learn more about this rapidly changing policy initiative.

The Commentary section features diverse and relevant topics that are useful for SMDM members including: a personal career development story from Miriam Kuppermann that vividly describes the multiple benefits of trans-disciplinary collaborations in medical decision making research; a moving appeal from Brian Zikmund-Fisher to speak directly with patients and the broader public about our research through outlets such as the; a thoughtful call from Eva Janssen and Erika Waters for consideration of patients’ feelings as well as their cognitions when considering risk-related information as part of a medical decision; and, valuable insight from Jorie Butler into a new stream of research that seeks ways to collect and display “contextual information” to enhance effective patient-physician decision making.

And, given the season, no respectable newsletter would fail to include an update on health policy legislation in the U.S. (or lack thereof) from our own Mark Liebow. On this note, we welcome similar updates on national health policy legislation from our SMDM members in Europe, Asia, and elsewhere. Please feel free to contact me ( if you’d like more information.

Member updates and announcements follow, including photos from the successful 16th biennial European SMDM Conference, Chaired by Olga Kostopoulou.

Last, we are actively seeking a Deputy Editor for our SMDM Newsletter. My term ends in the Spring of 2017. Serving as Deputy Editor and later, as Editor, are commitments that take some time, both are two of the most rewarding service contributions I’ve taken on during my career. As a relative newbie to SMDM, I’ve reached out to numerous members and made valuable research contacts as well as many good friends. Also, our great staff and the commitment of our Board make the job very manageable and even fun. So … if you’re interested, don’t be shy! I welcome emails or phone calls. Jill and I are also happy to meet with you in Vancouver to discuss details. Here again is my contact information: or call me at (808) 754-6370.

A hui hou, Dana

Value, by Mark Helfand 

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From the President: Value

by Mark Helfand, MD, MPH, Portland Veterans Affairs Medical Center and Oregon Health & Science University

In my past two columns, I discussed SMDM’s role in our careers and in the academic and public arenas. In this column, I want to talk about a specific example. What is SMDM’s role in a debate that concerns a topic that is near to what we think about and work on as individual researchers? 

The high cost of specialty drugs has revived interest in “value.” Just before the vote on the UK’s EU referendum at least one British newspaper, the Telegraph, had room for another story: â€œUK drugs watchdog Nice approves five new treatments in coup for Big Pharma.” The article said NICE agreed to “wave through” some expensive new oncology drugs after negotiating a lower price and a patient access scheme with the manufacturer. The “asking price” for a month of therapy was £4,923 (sorry, but there is no point in converting to other currencies today!). The negotiated price is undisclosed, but, according to the Guardian, the manufacturer agreed to bring the price “below Nice’s cost-effectiveness ceiling of £30,000 per year of quality life gained.”

In the UK, of course, NICE’s methods have been scrutinized for many years. I was glad for the scrutiny. It sparked innovation in methods for cost-effectiveness, many of which addressed valid concerns. The innovations led to many fine publications in Medical Decision Making when I was the editor-in-chief, but more importantly they improved how CEA was used in allocating resources. For example, several articles addressed how to weigh spending on providing a health care service against spending on new research and on implementation of the service or how to take account of the difference in value of the first and last pounds spent on implementation. Others addressed criticism that CEA takes a “one size fits all” approach, for example by proposing methods to take better account of heterogeneity of treatment effects (also known as individual differences) into estimating incremental cost-effectiveness ratios. Some articles made it easier to communicate the results of a CEA or the uncertainty related to them. Not all of the innovations came from investigators from countries that used CEA in policymaking, but ideas for the next generation of innovations often did.

In the US, meanwhile, Alan Garber wrote an editorial, “A Menu without Prices” (2008), that argued for using the methods of cost-effectiveness analysis in comparative effectiveness. In a rebuttal, Gail Wilensky argued that cost-effectiveness was important but should not be done by the government or by a national entity created by the government. Wilensky’s view, which was widely shared across the political spectrum, prevailed, and the entity, PCORI, stayed away from cost-effectiveness.  

For the next several years the main topic of discussion seemed to be whether it was better to euphemize or to demonize cost-effectiveness. After settling on a palatable term (“value”), public and private insurance and payers including the Centers for Medicare and Medicaid Services are again talking about it, using terms like value-based pricing, value-based frameworks, and value-based care. 

These terms are now all over the lay press. A guest column in USA Today, published last month, attacked the Institute for Clinical and Economic Review (ICER*), on several fronts. It said, for example, “ICER, which holds itself out as a kind of Consumer Reports for drugs, is basically an industry-backed comparative effectiveness calculator. That ICER is industry backed isn’t the problem, it’s that it uses comparative effectiveness to lend an air of legitimacy to the formulary shenanigans.” (Here the term “industry” refers to health insurers and payers.) In a further effort to belittle ICER’s credibility, the article notes that Steve Pearson, ICER’s president, “was awarded an Atlantic Fellowship by the British Government and acted as Senior Fellow at NICE.” 

Then The Hill, a US political web site, published an article about ICER, citing its recommendation that the price of melanoma treatments should be “from $432 to $974 per treatment vial” as an example of what, according to critics, is ICER’s greatest sin: estimating the price at which a treatment provides good value and bringing it into formulary discussions.  

A few days later, the House Republicans incorporated a value framework called “V-BID”, or value-based insurance design, into their proposal for revamping Medicare Advantage. V-BID, led by Mark Fendrick, MD, at the University of Michigan, focuses on lowering patients’ out of pocket costs for essential and high-value treatments. There are others, but all of the frameworks incorporate assumptions about how societal value should be estimated and about what part of that value should be retained by manufacturers as profit. They also require descriptions of value, risk, and health states, some of which involve numbers, but it is not clear yet what approaches to communicating about risk and value they will use.   

The National Pharmaceutical Council, a research arm of Pharma, reviewed 5 frameworks and listed these problems with them:

1. Untested Methods
2. Confusing Output
3.  Lack of Patient Centeredness
4.  Sub-Optimal Inputs
5.  Lack of a Systemwide Perspective

I don’t necessarily agree with all of these arguments. For one, I think outdated methods present a bigger problem than untested ones. Nevertheless, the NPC report is somewhat encouraging, because the objections are methodological rather than ideological. By contrast, the USA Today column argued that “comparative effectiveness” doesn’t take into account that “different people respond differently to medications. The blue pills don’t always work the same as the red pills. Individuals, it turns out, are different.” This is tired, uninformed rhetoric. In reality, taking better account of heterogeneity of treatment effects and of individuals’ preferences in clinical research and policy decisions is a high priority for comparative effectiveness and cost-effectiveness methodologists. The field of decision science is the vanguard of patient-centeredness, where tools for considering preferences in clinical decisions, clinical prediction, risk communication, and individualized decision support were developed.

I don’t think SMDM can or should speak with one voice on what “value framework” is best, but its members can contribute perspectives that are missing or underrepresented in the current conversation, particularly on the theoretical and ethical foundations of these proposals. ISPOR, the Milbank Foundation, which focuses on state governments in the US, and other organizations are jumping in, proposing their own “value frameworks”. It will be interesting to see what they come up with, but I don’t think panels are likely to find solutions to the problems with these frameworks. Methodologists might. At a minimum it is important that the panelists be aware of the innovations that, for the most part, are not part of the frameworks that are getting the most attention. 

A small study group within SMDM could be convened to critique the proposals, or individuals could. I want very much to hear what people think and invite you to email your ideas and views to me at

Addendum: Value pricing is not new. I associate it most closely with Steve Teutsch’s efforts, in the early 1990’s, which employed cost-effectiveness analysis to strengthen the US Centers for Disease Control’s hand in negotiating with pharmaceutical companies on behalf of the US Public Health Service. Currently, the CDC offers the Steven A Teutsch fellowship in “Prevention Effectiveness”, named after the book Teutsch and colleagues wrote about their program. Wikipedia does not have an entry for Dr. Teutsch. It should.

* In this article the acronym “ICER” means “Institute for Clinical and Economic Review” not “incremental cost effectiveness ratio.”  I don’t endorse it but it saves space.


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


The Pleasure of Transdisciplinary Research / The Challenge of Decision Making in Obstetrics 

by Miriam Kuppermann, PhD, MPH, UCSF School of Medicine

Over the years, numerous modes of collaboration across disciplines have been advocated: inter-disciplinary, multi-disciplinary, and cross-disciplinary, to name just a few. More recently, transdisciplinary research has taken center stage, defined as collaboration by team members representing diverse disciplines who jointly create new models of conceptualizing or addressing a problem. Like most of you, over the course of my career, I have collaborated with many different investigators from a wide range of disciplines. One of the most successful – and enjoyable! – collaborations that I have experienced, however, was being a member of the Obstetrics and Gynecology Risk Research Group (OGRRG) – a true transdisciplinary endeavor.

OGRRG was created by Annie Lyerly, MD, MA, an obstetrician with an MA in philosophy, who completed a Greenwall Fellowship in Bioethics and Health Policy at Georgetown and Johns Hopkins Universities, and Maggie Little, PhD, a professor of philosophy who is Director of the Kennedy Institute of Ethics at Georgetown University. Their goal in establishing this group was to bring together scholars from various disciplines to think about how risk is conceived, assessed and managed in pregnancy and to tackle some of the thorny issues that arise in the context of pregnancy, where the needs of both the pregnant woman as well as the fetus must be considered and where distortions in thinking often occur. There were seven of us in total, including two practicing obstetricians (in addition to Annie, Lisa Harris, who is an obstetrician and historian), two philosophers, one sociologist, one anthropologist, and one epidemiologist/decision scientist. Over the course of several years, we met face-to-face 2 to 3 times annually, for 2 to 3 days at a time (often at airport hotels), to engage in intense conversations regarding three major fallacies in obstetric decision making: 1) considering the probabilities of undesirable outcomes alone, in isolation from women’s values and social contexts, as determinative of individual clinical decisions and health policy; 2) regarding any risk to the fetus, including incremental risks that would in other contexts be regarded as acceptable, as trumping considerations that may be substantially more important to the well-being of the pregnant woman; and 3) focusing on the risks associated with undertaking medical interventions during pregnancy to the exclusion of demonstrable risks to both woman and fetus of failing to intervene.

These discussions led to several publications and numerous funded grant proposals designed to rectify the problems we identified as resulting from this distorted thinking. More personally, it also led to a whole new context in which to frame my own work, along with deep connections and lasting friendships with brilliant investigators from fields far removed from my own – colleagues I would have never had the opportunity to meet and work with without the foresight of Annie and Maggie and their commitment to transdisciplinary work. I feel so lucky to have been a part of this group, and I hope all of you will find the time and inclination to join – or form – such a group during your careers.

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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.


Who Are You Writing For? 

by Brian J. Zikmund-Fisher, PhD, University of Michigan

Most academics write for people exactly like themselves. We write journal articles for people with similar academic training, methodological expertise, topical interests, and expectations.

But who needs our work most? 

Not us. It’s the clinicians who need the results of our modeling exercises to make better decisions. It’s the patient educators who have to talk about risk with dozens of patients a day. It’s the policy makers who need to look at the problems they care about a new way.

How often do we speak directly to them? 

Not enough. We complain about the lack of science literacy and yet don’t provide our own science in ways that anyone outside of our own communities can possibly understand. 

I believe that all academics, but especially those of us in interdisciplinary fields such as medical decision making, have an obligation to do what is often termed public engagement. Put more simply, we need to write for our grandmothers and friends and poker buddies, not just our academic colleagues.

One way to do so is, which publishes commentary and analysis pieces exclusively authored by academics (you must have an academic email to register to write) and edited by professional editors for a public audience.The byline goes to the academic (so it can go on your CV). All articles are free to read and free to republish. In fact, many larger media outlets such as Slate, the Washington Post, and Huffington Post will republish TheConversation pieces. 

How do they do it? TheConversation has no ads. Just buy in and funding from some of the largest charitable funds and most prestigious universities in the world. It started about 4 years ago in Australia but now boasts editions in the UK, US, France, and Africa. 

I have no affiliation with TheConversation, nor do I receive any money or anything else from them. I have written a few pieces for them. That’s it. 

(BTW: The latest one, co-authored with Laura Scherer, Victoria Shaffer, and Niraj Patel, was read 4,200 times in the first 3 weeks. I doubt any of my journal articles have been read by 4,200 people, ever.)

I simply think that this site is an incredibly transformative opportunity for academics to use to speak to the media, and through them, the public. To put our written words where they can perhaps do the most good.

So, here’s my challenge to the membership of SMDM: If we believe that SMDM research is relevant to the larger world, then we need to write like it is. Pick a topic that you are passionate about. A piece of your work that is underused. An issue that MDM methods are needed to resolve. And then write something for the broader public about it, through TheConversation or elsewhere.

Medical decision making is part of innumerable critically important conversations in the world.

Let’s speak up.

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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.


Feelings of Risk in Health Decision Making

by Eva Janssen, PhD, Maastricht University and Erika A. Waters, MPH, PhD, Washington University in St. Louis

 â€œâ€¦. To me, I felt like, that it’s in my family so I did feel more at risk personally. I don’t care what the number said, to be honest. [laughs] (…) Actually, statistically I wasn’t all that high.” *

The above quotation illustrates how women used their feelings, rather than probabilistic information, to evaluate the risks and benefits of participating in a breast cancer chemoprevention trial. By demonstrating that health decisions are not solely based on a quantitative risk-benefit analysis of probabilities derived from populations, it echoes early research by Paul Slovic and others, which emphasized the rich, multidimensional, and affective nature of health risk beliefs. Multiple international research programs have provided recent support for this hypothesis by reporting that individuals’ feelings about a risk are more strongly related to health decision making than their thoughts about a risk. It is posited that risk feelings, which originate from a variety of personal and vicarious experiences (e.g., having a mother with breast cancer), may reflect a more accessible way of thinking about risk compared to cognitive probability judgments.

For this reason, it is important to critically examine the risk communication strategies used in decision support tools and health behavior interventions. Are we on the right track? Currently, most risk communications focus on changing cognitions about the hazard, and little research has investigated which strategies can be used to address risk feelings. Addressing the affective dimension of risk perceptions might be particularly relevant for decisions about an affectively-loaded disease such as cancer. For example, using narratives might play an important role in some health communications because they are thought to produce stronger affective responses due to their stimulation of mental imagery.

The importance of considering affect in designing health decision making interventions was identified as a key research need during the “crosstalk” sessions held during the 2015 Society of Behavioral Medicine and the Society for Medical Decision Making annual meetings. Those sessions, titled “What is a “Good” Medical Decision? Perspectives from Multiple Stakeholders,” concluded that, rather than impeding “good” decision making, affect can help patients make sense of their situations and place their decisions into the broader context of their lives.

Consequently, we agree with the growing number of researchers and practitioners who assert that the potential of risk communication may only be fully realised by taking the motivational power of feelings into account. To this end, we are evaluating different risk communicating strategies on both cognitive and affective risk outcomes. The results will be used to optimize health communications and better serve the needs of the general public. For more information, you are welcome to contact me at

* Holmberg C, Waters EA, Whitehouse K, Daly M, McCaskill-Stevens W. My Lived Experiences Are More Important Than Your Probabilities The Role of Individualized Risk Estimates for Decision Making about Participation in the Study of Tamoxifen and Raloxifene (STAR). Medical Decision Making. 2015 Nov 1;35(8):1010-22.

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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.


Shared Decision Making and Patient Centered Care

by Jorie Butler, PhD, University of Utah School of Medicine

For providers, seeing the patient as a whole person may be a critical component of fostering shared decision making. In primary care, shared decisions are not restricted to a single visit, but part of a longitudinal process. Vivid information from a patient – such as explaining the impact of the symptoms the patient is experiencing or describing personal goals such as a hiking vacation – may reset the relationship so that the patient and provider are able to be on the same page. Contextual information about patients – such as information about their job, social environment, and personal goals - and systematic values elicitation or clarification can provide information that supports the provider and patient in making shared decisions.

Incorporating contextual information about patients into patient care and decision making is a tough task for providers. They may not know how contextual information applies to the decisions to be made and not be sure how to use it. In the limited time of a clinic visit, taking the time to elicit contextual information may be a challenge. How can we collect contextual information about patients to enhance the patient provider relationship as well as to improve the quality of decisions made? Will storing and displaying contextual information in the electronic health record foster a climate of shared decision making? Will this approach support the needs of specific and vulnerable patient groups such as geriatric patients? Is there specific (in type or content) information that is particularly influential in fostering a climate of shared decision-making?

In a major effort to update the existing electronic health record system, the VA is developing an Enterprise Health Management Platform (eHMP) to support providers across VA. A team is working with the eHMP development team and key VA program offices including the Office of Patient Centered Care and Cultural Transformation and the Office of Connected Care to support collaborations that include the collection of contextual information from patients and display of this information to providers in useful and easy to understand ways. This effort has the potential to enhance and improve care across the VA and in other healthcare systems.  

Jorie Butler is an Assistant Professor in the Department of Internal Medicine, Division of Geriatrics at the University of Utah School of Medicine. She is a researcher at the Salt Lake City VA in the Health Services Research and Development Center of Innovation (HSR&D COIN) and Associate Director of Education and Evaluation at the Geriatrics Research Education and Clinical Center (GRECC).

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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.


U.S. Health Policy: Nothing New (Again)

by Mark Liebow, MD, MPH, Mayo Clinic

The Federal government doesn’t usually do as much policy making in an American Presidential election year and this year is no exception. Congress is in session less than usual with extra time off for national conventions and for incumbents to campaign for re-election. Neither Trump nor Clinton has focused much on health policy in their campaigns so far.

The Senate Appropriations Committee surprised many by passing its Labor-HHS appropriations bill June 9 by a 29-1 vote. This bill, almost free of policy riders, would give $2 billion more to the NIH (though a substantial percentage is earmarked) and keep funding almost flat for most other agencies funding MDM covered by this bill. However, the House of Representatives is not as far along. Given how little Congress will be in session in the summer, it’s almost certain a continuing resolution will be needed to keep the government fully open after September 30.
In April, Andrew Bindman, M.D., an experienced researcher, was appointed the Director of the Agency for Healthcare Research and Quality (AHRQ). He has minimal medical decision making research background, however.

The Senate decided to take a different approach to how the House handled the content in the 21st Century Cures Act it passed last year. The Senate is considering and passing many small bills to cover the same material. These bills have enough changes that they will have to go to a conference committee to be reconciled. Some of the legislation may create research opportunities for MDM research.

PCORI continues to fund grants. While Congress is no longer trying to abolish it, its authorization under the ACA expires in three years and so its source of funding may expire then. It has been a significant source of funding lately for shared-decision making and other forms of MDM research. 
If Trump wins the Presidential election, it’s likely Federal research funding in the U.S will be cut. It’s not clear what a Clinton victory would mean for funding. When the United Kingdom leaves the European Union, it may depress both economies (and possibly others around the world), which usually means less money for research.

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SMDM meetings provide a highly interactive forum for discussion of novel research based on decision and behavior theory and analytical models applied to health related decisions. Presentations of original research, keynote talks, special symposia and short courses offer attendees the opportunity to explore diverse topics in medical decision making and the unique ability to connect with colleagues one to one. We hope to see you there!

SMDM 16th Biennial European Conference

This year’s SMDM 16th Biennial European Conference was a tremendous success! London set the perfect backdrop for this dynamic event. Special thanks to our Chair, Olga Kostopoulou, PhD, MSc, Imperial College London and Co-chairs, Anne Stiggelbout, PhD, Leiden University Medical Center, and Elisabeth Fenwick, PhD, MSc, ICON Health Economics, for planning a wonderful and enriching conference. We appreciate all who presented, attended and shared in this event!

London Meeting

Photos courtesy of Brendan Delaney, Olga Kostopoulou and Robert Hamm.

Lee B. Lusted Award Winners

Special congratulations to Fernando Alarid-Escudero (r) and Kine Pedersen (l), winners of the 2016 ‪SMDM European Conference Lee B. Lusted Award for Outstanding Presentation.

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38th Annual North American Meeting 

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

This year's annual North American meeting will be held October 23 - 26, 2016, at the Westin Bayshore, in Vancouver, BC, Canada. The 38th annual SMDM meeting offers researchers, clinicians, and provincial, state, and national health authorities the opportunity to exchange insights, tools, and new challenges in moving from uncertainty to action

As Ellen Peters wrote, “uncertainty abounds” in health care decisions. From decision models to decision aids and prediction tools, incorporating and communicating uncertain information is key to transparent, informed decision-making for individuals, clinicians, and policy makers. For over 30 years, SMDM members have sought to improve decision-making while accounting for uncertainty about the magnitude and severity of benefits and risks, the strength of current evidence, and how to weigh risks and benefits from the perspectives of the individual, health system, and society. Join us as we explore these issues in the beautiful city of Vancouver!

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
Lee B. Lusted Student Abstract Co-Chairs: Ankur Pandya, PhD and Eva Enns, MS


Make Your Hotel Reservations Now

Westin Bayshore Hotel

Hotel reservations in the SMDM block are now open! 
SMDM Block Room Rate - $184 CAD
Room block deadline: Friday, September 23, 2016 (subject to availability)


And check these links to plan your trip!

Entry Requirements to Canada:

Things to do In Vancouver:

Sponsorship Opportunities:

Meeting Registration will open soon!
Get on the mailing list to be the first to know!

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MDM Policy & Practice

SMDM's new open access journal Medical Decision Making Policy & Practice has just published its first collection of articles!

Come read at

Also pleased to announce four new Associate Editors of MDM and MDM P&P: Josephine Mauskopf, Ivar Kristiansen, Anushua Sinha, and Erika Waters.

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Deputy Editor Opening

The SMDM E-Newsletter needs your ideas and participation!
SMDM is looking for a Deputy Editor for its E-Newsletter. The deputy editor assists the editor-in-chief (EIC), with the collection, organization, and editing of the articles. It is the hope that the deputy editor will move into the position of EIC after about one-year then serve a EIC for 2 years.
Your contribution will be far reaching — the e-newsletter is viewed by an international audience. All 1000+ SMDM members receive the SMDM E-Newsletter in their inbox quarterly; in addition, the E-Newsletter is posted on the web and is accessible to all. Editors have the opportunity to participate in SMDM board meetings, which provides a great opportunity for exposure to the Society’s leadership. Whether you’re a new member or an “experienced” member of the Society — there could be a great role for you!
Interested in learning more? Contact Dana Alden at

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What Are You Working On?

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. 

submitted by: Simon Krabbe, MD, PhD fellow, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, Denmark

I am interested in improving the prediction models in patients with rheumatoid arthritis and spondyloarthritis, and in modeling the outcomes of treatment strategies that stratify the patients according to the prediction models. 

submitted by: Heather Gold, PhD, New York University School of Medicine

Much of my recent research is focused on multi-morbidity, that is, the situation where patients have multiple health conditions that interact with each other and with their health and healthcare utilization. Currently, I have a project focused on treatments and outcomes in breast cancer patients with diabetes. The study uses large, secondary data sources. Other initiatives we are pursuing include a comparative effectiveness trial to evaluate the effectiveness and cost-effectiveness of tobacco cessation in orthopaedic surgery patients and the impact of other comorbidities on additional cancer sites. I am particularly interested in finding colleagues who are developing statistical or cost-effectiveness models that address multi-morbidity and the interaction of conditions on health outcomes. Competing risk assumptions often are invalid in this framework. Our methods must get more sophisticated to evaluate the impact of multi-morbidity.  
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Members in the News

Anirban Basu, PhD, was elected 2016 Fellow of the American Statistical Association and is the recipient of the ISPOR Research Excellence Award in Methodology in Pharmacoeconomics and Health Outcomes Research for his article that appeared in MDM: A Framework for Prioritizing Research Investments in Precision Medicine.

Denny John, MBA, MPH, FRSPH, was appointed Adjunct Faculty-Economic Evaluation, School of Public Health, SRM University, Chennai, for teaching MPH students. He also recently published: Shukla, V., Nimbalkar, S., Ganjiwale, J., & John, D. (2016). Direct costs of critical illness associated healthcare expenditure among children admitted in Pediatric Intensive Care Unit in rural India. Indian Journal of Pediatrics. DOI: 10.1007/s12098-016-2165-4

Marieke de Vries, PhD, recently moved from Tilburg University to Radboud University in Nijmegen, the Netherlands. She is coordinator of the Health Innovation track of the Science, Management and Innovation master specialization at the Faculty of Science, Radboud University and will continue her research program on health innovation (e.g., studies on patient decision aid design and implementation, shared decision making, measuring subjective well-being in health economics) in Nijmegen. She would love to welcome you in Nijmegen, the Netherlands, so please, drop her a line if you would like to stop by.

Jeffrey S. Hoch, PhD, recently moved to the University of California at Davis (UCD) where he is Professor in the Department of Public Health Sciences and the Associate Director of the Center for Healthcare Policy and Research.

New article by Jiaru Bai (UC Irvine), Cristina del Campo (Universidad Complutense de Madrid and UCI visitor in 2016), L. Robin Keller (UCI):  “Markov Chain Models in Practice: A Review of Low Cost Software Options”, Publication in Spanish: “Modelos de Cadenas de Markov en la Práctica:  Una Revisión de Opciones de Software de Bajo Coste”, forthcoming in 2017, Investigación Operacional. This paper was written in Spanish to facilitate communication with Spanish-speaking scholars in Cuba and elsewhere, who aim to conduct Markov cost effectiveness analyses and would benefit from low cost software alternatives. This is a follow-up to Lindsey E. Minion, MD (Univ. of Arizona Cancer Center & Creighton University at St. Joseph’s Hospital and Medical Center, Phoenix); Jiaru Bai (Merage doctoral student); Bradley J. Monk, MD (Gynecologic Oncology, UCI); L. Robin Keller, PhD; Ramez N. Eskander, MD (Gynecologic Oncology, UCI); Gareth K. Forde, MD, PhD, MBA (Gynecologic Oncology, UCI) ; John K. Chan, MD (California Pacific Palo Alto Medical Foundation, Sutter Cancer Institute, San Francisco), Krishnansu S. Tewari (Gynecologic Oncology, UCI), “A Markov Model to Evaluate Cost-Effectiveness of Antiangiogenesis Therapy Using Bevacizumab in Advanced Cervical Cancer”,  Gynecologic Oncology,  Vol. 137, Issue 3, June 2015, pages 490-496.

A recent article published in Inflammatory Bowel Diseases sought to better understand what aspects of Ulcerative Colitis (UC) are most concerning to patients and how they would like to be informed about treatment options. Of 460 patients with UC, 87% wanted to share treatment decision making with their doctors and 98% wanted more than just a basic understanding of their disease. Questions about patient concerns revealed UC patients were most concerned about the risk of colorectal cancer (37%) and the possible need for an ileostomy (29%). Only 14% of patients indicated that side effects from medications were their biggest concern. Despite the concern about colon cancer, 78% only wanted to hear about surgical treatment options as a last resort. Following the study, these and other insights informed the development of a multimedia decision aid for UC treatment options. Dr. Corey Siegel and Geri Baumblatt will discuss the research and how it informed a decision aid about treatment options for Ulcerative Colitis on July 19th at 2pm ET. For details about the free webinar, email:

Erika A. Waters, PhD, MPH, was promoted to Associate Professor with tenure at Washington University, St. Louis School of Medicine.

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Job Postings

Senior Science Advisor, Center for Evidence and Practice Improvement, AHRQ

Exciting opportunity at the Agency for Healthcare Research and Quality (AHRQ) in the Center for Evidence and Practice Improvement (CEPI) to provide expert consultation and mentoring on diverse scientific and methodological issues related to health services and implementation research.

CEPI generates new knowledge, synthesizes evidence, translates science on what works in health and health care delivery, and catalyzes practice improvement across health care settings. The Senior Science Advisor will formulate and implement the Center’s extramural and intramural research agenda, and will lead the integration and alignment of programs across the Divisions of the Center.

The successful candidate should have a medical degree or other doctoral degree in a health related field with extensive experience in providing consultation or guidance on health services research and methodology, or conducting health services and implementation research to promote or apply evidence-based practices, and analyzing and evaluating current research to inform research projects that impact policy, clinical practice and/or methodology. The Senior Science Advisor will represent the Center and Agency at national research meetings and high-level Departmental committees and working groups.

To apply use the following links: 
Medical Officer
Health Scientist Administrator
Health Scientist Administrator (MP)

CEPI will have job openings in the areas of Decision Science and Patient Engagement, Practice Improvement and Dissemination and Implementation of PCOR findings. Openings coming soon in USAJOBs ( Please share with colleagues who may be interested in applying.

Keep posted on new job opportunities in the Resource Section of SMDM Connect

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SMDM Lifetime Contributors

SMDM extends its heartfelt appreciation to members for their charitable contributions over the years!
Raiffa-Kahneman Circle 
(Contributions total $5,000 or more)
John Clarke ('13, '14, '16)
Jeremy Goldhaber-Fiebert ('13, '14)
Mark Helfand (‘05, ‘07, '10, '11)
Michael Kattan ('13 - '16)
Joseph King (‘06 - '15)
James Stahl, Stahl Family/Stahl Bioethics Foundation in honor of Dr. Eva Bamberger Stahl (‘06, ‘09, '10, '12, ‘15)

Pareto Level
(Contributions total $1,000 - $4,999)
Dana Alden ('12 - ‘15)
Michael Barry (‘06 - '10)
Ahmed Bayoumi (‘06, '08 - ‘15)
Dennis Fryback (‘05 -'15)
Murray Krahn ('13, '14)
William Lawrence (‘06, '10, '11, '13, ‘15)
Jill Metcalf (‘07 - '15)
David Rovner & Margaret Holmes-Rovner (‘05 - '15)
Bruce Schackman (‘06 -'15)
Marilyn Schapira (‘07 - '12, '14 - '15)
Uwe Siebert ('11, '13, '14)
Frank Sonnenberg (‘06, ‘09)
Harold and Carol Sox ('10 - '15)
Sankey Williams (‘06 - ‘08, '13, '14)
John Wong (‘06, - '13)

Edwards Level
(Contributions total $750 - $999)
Ahmed Bayoumi (‘06, '08 - ‘14)
Scott Cantor & Lisa Stone (‘07 - '15) 
Neal Dawson (‘05 - '15)
Sara Knight (‘05 - '15)
David Meltzer ('07, '09)
Stephen Pauker (‘06, ‘09)
Mark Roberts (‘08, ‘09, '13, ‘15)
Seema Sonnad (‘06, ‘07, ‘09, '12 - '14)
Joel Tsevat (‘06, ‘09, '10)

Tversky Level
(Contributions total $500 - $749)
Anirban Basu ('13)
Robert Beck (‘07) 
Donald Brand ('13 - '15)
Kate Christensen (‘09)
Nananda Col (‘05 - ‘09)
Angela Fagerlin ('14 – ‘15)
Peder Halvorsen ('11 - '15)
Myriam Hunink (‘05 - '14)
Steven Kymes (‘05 - ‘09, '12, '15)
Kathryn McDonald (‘07, '09, '10, '14, ‘15)
David Paltiel ('07, '09)
Alan Schwartz (‘07, '10 - '15)
David Sugano (‘07, ’09 – '11, '13)
Jef van den Ende (’10, '14)

von Neumann-Morgenstern Level
(Contributions total $250 - $499)
Amber Barnato (‘05, ‘07, '11, '12, '14)
Dena Bravata (‘06, ’09 -  '11)
Andy Briggs ('14)
Randall Cebul (‘06, ‘08, '10)
Mark Eckman (’06, ‘09)
Elena Elkin (‘07, '14)
Arthur Elstein (‘06, ‘07, ‘09, ‘10) 
Heather Taffet Gold (‘08, '11, '14)
Don Husereau ('13)
Karen Kuntz (‘09, '11)
Miriam Kuppermann (‘06 - '10, '12, '14 - '15)
Thomas Tape ('10, '11, '14)
Robert Wigton ('10, '11, '14)

Markov Level
(Contributions total $100 - $249)
Cathy Bradley (‘07)
Scott Braithwaite (’09)
Linda Canty ('12)
Jag Chhatwal ('15)
Phaedra Corso (‘06, ‘07, ‘08)
Magdelena Flatscher-Thöni ('14)
Liz Fenwick ('14 – ‘15)
Alan Garber ('10)
Robert Hamm (‘06, ‘08, '14)
Joseph Johnston (’15)
Paal Joranger (‘14)
Esther Kaufmann ('11)
Sun-Young Kim (‘07, ‘08, ‘10, '13)
Joseph Ladapo ('12 - '15)
Curtis Langlotz ('12)
Lisa Maillart ('10)
Peter Neumann ('14 – ‘15)
Richard Orr (‘05, ‘06)
Jesse D. Ortendahl ('11, '12, '13)
Mary Politi ('14, ‘15)
Roy Poses ('14)
Brian Rittenhouse (‘07)
Ursula Rochau ('14)
Allison Rosen (‘07)
Natasha Stout ('14)
Verena Stühlinger ('14)
Joanne Sutherland (‘08, ‘09)
John Thornbury (‘05)
George Torrance (‘05)
Benjavan Upatising ('13)
Brian Zikmund-Fisher (‘08 - '15)

Bayes Level
(Contributions total up to $100)
Jessica Ancker ('14)
Hilary Bekker ('12)
Eran Bendavid ('11)
Tanya Bentley ('14)
Denise Bijlenga (‘08)
Kimberly Blake (‘09)
Cindy Bryce ('14)
Rowland Chang (‘06, ‘07)
Carmel Crock (‘09)
James Dolan (‘09)
Arna Dresser ('10, 12, '14)
Rohan D'Sousa ('15)
Ted Ganiats (‘05)
Lee Green (‘07, ‘09)
Amit Gupta (‘06)
Michael Hagen ('10)
Negin Hajizadeh ('14)
Sarah Hawley ('14)
Kristin Hendrix ('14)
David Howard (‘09)
David Katz (’08)
Job Kievit (‘09)
Kerry Kilbridge (‘05, ‘07, ‘08)
April Kimmel ('14)
Sarah Kobrin ('14)
Ivar Sonbo Kristiansen ('10)
Andrew Scott LaJoie ('10)
Clara Lee ('15)
Sarah Lillie ('14 – ‘15)
Andreas Maetzel (‘09)
Daniel Masica (‘08)
Evan Myers ('12)
Thomas B. Newman ('10)
Jane Pai ('10)
George Papadopoulos (‘08)
Lisa Prosser (‘08)
Valeria Reyna ('14)
Michael Rothberg (‘09 - '12)
Gillian Sanders (‘07)
Jha Saurabh (‘09)
Karen Sepucha ('14)
Ewout Steyerberg (‘06, ‘09, '11, '13)
Anne Stiggelbout (‘06)
Carol Stockman (‘05)
Danielle Timmermans (‘07)
Thomas Trikalinos (’15)
Hugues Vaillancourt ('11)
Erika Waters ('14)
Milton Weinstein (‘09, '11)
Robert Werner (‘08)
Holly Witteman ('14)
Eve Wittenberg ('14)
Theodore Yuo ('15)

Donations received Oct. 2005 – June 28, 2016.
Bolded individuals made contributions since the last report. 
Italicized individuals moved up a level of giving in 2016.
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