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May 30, 1977

Decision Analysis-Reply

JAMA. 1977;237(22):2380. doi:10.1001/jama.1977.03270490020008

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Dr Keeler argues from the erroneous assumption that medical information can be obtained without cost. Some new knowledge may be more inexpensive than others, but none is free.

As Dr Keeler points out, the information from the liver scan was not discriminating in the example of the article, but this conclusion was derived from calculations based on probabilities and outcome values pertaining to the situation. Without the calculations, either by Bayes Theorem or through decision analysis, the value or hazard of using liver scan data in making a therapeutic decision was unknown. If interpretations of liver scans are determined to be misleading and, therefore, not to be used, then a liver scan should not be performed. The scan is not costless.

Physicians should think and then act, not the reverse. In complex medical problems, decision analysis will explicitly portray the possible lines of action and their consequences; thereby,