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Decision theory's role in medicine will lie between the extremes of naive optimism ("a Rosetta stone") and unmitigated pessimism ("a computerized Ouija board"). Its application to public health policy, research, and administrative problem-solving is established; experience offers some guidelines for more limited use in clinical practice.
Information and decision theory were applied to assess the interpretation results of 15 computer programs (9 electrocardiogram and 6 vectorcardiogram) and 9 cardiologists; 8 of whom analyzed the electrocardiogram and 5 the vectorcardiogram, using a database of 1,220 clinically validated cases. The study demonstrates that information content and utility indices, by providing a comprehensive view of diagnostic performance, can enhance the insight given by the more classic statistical performance measures.
Responses to electrical stimulation of the tooth pulp were obtained in both baseline and test sessions for subjects receiving acupuncture, 33 per cent nitrous oxide, or control conditions. A signal-detection analysis across sessions showed that both treatment groups demonstrated reduced sensitivity to stimulation, and increases in bias against reporting strong stimuli as painful. (Key words: Acupuncture; Anesthetics, gases, nitrous oxide; Measurement techniques, sensory decision theory; Pain, sensory decision theory).
Six radiologists reviewed 50 urograms to determine whether arteriography or needle aspiration should be recommended for evaluation of a space-occupying renal lesion. In addition to their usual decision methods, they were encouraged to think about the problem from a decision theory viewpoint. No computations were required. It was found that even informal, non-numerical application of decision theory resulted in improved outcomes; further improvement was noted with explicit use of numerical methods.
In two separate experiments, the latencies associated with all four categories of response (correct detections, false alarms, correct rejections, and omissions) were recorded during the performance of a 45-min. visual monitoring task. In the first experiment, concerned primarily with criterion changes in vigilance, signal probability was manipulated. The second experiment was concerned with sensitivity changes resulting from changes in event rate. In the first experiment, latencies associated with correct detections and false alarms increased, whereas those associated with correct rejections and omission errors decreased, with an increase in criterion. In the second experiment, a reduction in sensitivity associated with an increased event rate exerted significant and opposing effects on latencies of responses to signals (correct detections and omissions) while leaving the latencies of responses to nonsignals (correct rejections and false alarms) unchanged. In both experiments, it was observed that while the latencies associated with positive responses increased with time on task, the latencies of negative responses decreased with time. These results are consistent with the predictions of a decision theory model for response latency extended from signal detection theory, which assumes an inverse relation between response latency and distance from the criterion; A decision theory analysis thus enables the interpretation of both detectability and latency measures of vigilance performance within the same theoretical framework.
Subjects exposed to social models dissimulating tolerance or intolerance generally exhibit matching behavior in their verbal ratings of painful stimulation. It has been unclear, however, whether these changes reflect voluntary alteration of evidence or genuine changes in distress. This study used alternative measures and controlled for methodological limitations of earlier studies by examining nonpalmar skin potential in addition to palmar skin conductance and heart rate indexes of psychophysiological response to electric shock, and by evaluating verbal expressions of pain with sensory decision theory methodology. Of 20 female volunteer subjects, half served as controls, and half were exposed to a tolerant female model. Both the subject and the model verbalized ratings of discomfort provoked by a series of electric shocks of increasing intensity. Subjects then underwent a series of preselected random shocks. Sensory decision theory analyses revealed lower discriminability of the shocks among subjects exposed to a tolerant model. Several indexes of nonpalmar skin potential and heart rate reactivity exhibited lower reactivity in the tolerant group. Tolerant modeling was also associated with decreases in subjective stress. The results were consistent with the position that changes in pain indexes associated with exposure to a tolerant model represented variations in fundamental characteristics of painful experiences as opposed to suppression of information.
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The effect of 80 min of low frequency (2 Hz) electric acupunctural stimulation at facial sites on the perception of induced dental pain was evaluated using both pain threshold and sensory decision theory (SDT) procedures. The demonstration of a 187% increase in threshold over a 20 min period of acupunctural stimulation replicated earlier work by Swedish investigators. SDT analyses indicated that the threshold increase reflected a relatively pure sensory change with no significant modification of response bias. However, subjects were able to perceive some of the stimuli presented below threshold level following acupuncture, thus indicating that the threshold concept has been an inadequate description of the phenomenon. This study demonstrated that intrasegmental analgesic stimulation is more efficacious than the extrasegmental meridian point stimulation used in our earlier studies. Possible mechanisms for the observed effect were discussed.
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