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February 14, 1977

Decision Analysis

Author Affiliations

The Robert Wood Johnson Foundation Clinical Scholar Program Royal Victoria Hospital Montreal

JAMA. 1977;237(7):641-642. doi:10.1001/jama.1977.03270340027006

To the Editor.—  Increasing amounts of attention have been given recently to the statistical tool of decision analysis and its applicability to clinical medicine. The recent article by Sisson and associates gives a clear exposition of certain aspects of DA, but both the strengths and limitations of decision analysis are misrepresented.In the second example, Sisson et al consider the advantages and disadvantages derived from the use of liver scanning to determine operability in bronchogenic cancer. They determine, by means of some arbitrary assumptions, that the outcome "value" is essentially the same whether or not the isotope procedure is performed, and conclude that, therefore, there is "... no advantage accrued to scanning the liver and this costs time and money." This conclusion is wrong: although the two alternatives may be equivalent medically, there are other reasons for choosing between them.Although the costs of scanning are considered by the authors, the