Barbara McNeil

Who they are

Barbara J. McNeil is first author of the 1982 New England Journal of Medicine paper On the elicitation of preferences for alternative therapies, written with Stephen Pauker, Harold Sox and Amos Tversky. The paper put a framing question to 238 ambulatory patients with chronic medical conditions, 491 graduate students and 424 physicians.

Key papers

McNeil, Pauker, Sox and Tversky (1982), New England Journal of Medicine 306(21), 1259-1262. The study compared surgery with radiation therapy for lung cancer. Its participants were 238 ambulatory patients with chronic medical conditions, 491 graduate students and 424 physicians. In all three groups, surgery was substantially more attractive relative to radiation under three presentation conditions: when the treatments were identified rather than unidentified, when the information was given as life expectancy rather than cumulative probability, and when the outcome was framed as the probability of living rather than the probability of dying. Respondents were asked to imagine that they had lung cancer and to choose between the two therapies using both cumulative probabilities and life-expectancy data, and different groups received input that differed only in whether the treatments were named and whether outcomes were stated as living or dying. The authors suggest that awareness of these effects among physicians and patients could help reduce bias and improve the quality of medical decision making.

Key ideas

The study reports that the physicians in the sample were affected by the presentation as well as the students and patients. It is about how treatments are described and makes no claim about which treatment is better.

Its medical problem was later re-examined by Macchi and Zulato (2021), who argued that the reversal in the mortality frame arises from the cumulative number format, which many participants read as numbers that did not add up. In their second study, a linear layout removed the framing effect, with 73 and 71 per cent choosing surgery in the two frames. Their first study reproduced the original pattern.

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