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Improving Clinical Guidelines and Decisions under Uncertainty

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  • Charles F. Manski

Abstract

This paper discusses how limited ability to assess patient risk of illness and predict treatment response may affect the welfare achieved by adherence to clinical practice guidelines and by decentralized clinical practice. I explain why predictive ability has been limited, calling attention to imperfections in clinical judgment and to questionable methodological practices in the research that supports evidence-based medicine. I discuss recent econometric research that can improve the ability of guideline developers and clinicians to predict patient outcomes. Recognizing that uncertainty will continue to afflict medical decision making, I apply basic decision theory to suggest reasonable decision criteria with well-understood welfare properties.

Suggested Citation

  • Charles F. Manski, 2017. "Improving Clinical Guidelines and Decisions under Uncertainty," NBER Working Papers 23915, National Bureau of Economic Research, Inc.
    • Handle: RePEc:nbr:nberwo:23915
    Note: EH TWP
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    References listed on IDEAS

    as
    1. Charles F. Manski, 2013. "Response to the Review of ‘Public Policy in an Uncertain World’," Economic Journal, Royal Economic Society, vol. 0, pages 412-415, August.
    2. Manski, Charles F, 1990. "Nonparametric Bounds on Treatment Effects," American Economic Review, American Economic Association, vol. 80(2), pages 319-323, May.
    3. John P A Ioannidis, 2005. "Why Most Published Research Findings Are False," PLOS Medicine, Public Library of Science, vol. 2(8), pages 1-1, August.
    4. repec:adr:anecst:y:2008:i:91-92:p:05 is not listed on IDEAS
    5. Horowitz, Joel L & Manski, Charles F, 1995. "Identification and Robustness with Contaminated and Corrupted Data," Econometrica, Econometric Society, vol. 63(2), pages 281-302, March.
    6. Charles F. Manski & John V. Pepper, 2000. "Monotone Instrumental Variables, with an Application to the Returns to Schooling," Econometrica, Econometric Society, vol. 68(4), pages 997-1012, July.
    7. Stoye, Jörg, 2009. "Minimax regret treatment choice with finite samples," Journal of Econometrics, Elsevier, vol. 151(1), pages 70-81, July.
    8. Manski, Charles F., 2013. "Public Policy in an Uncertain World: Analysis and Decisions," Economics Books, Harvard University Press, number 9780674066892, Spring.
    9. Karl Schlag, 2006. "ELEVEN - Tests needed for a Recommendation," Economics Working Papers ECO2006/2, European University Institute.
    10. Charles F. Manski, 2009. "The 2009 Lawrence R. Klein Lecture: Diversified Treatment Under Ambiguity," International Economic Review, Department of Economics, University of Pennsylvania and Osaka University Institute of Social and Economic Research Association, vol. 50(4), pages 1013-1041, November.
    11. Ronald L. Wasserstein & Nicole A. Lazar, 2016. "The ASA's Statement on p -Values: Context, Process, and Purpose," The American Statistician, Taylor & Francis Journals, vol. 70(2), pages 129-133, May.
    12. Charles F. Manski, 2008. "Studying Treatment Response to Inform Treatment Choice," Annals of Economics and Statistics, GENES, issue 91-92, pages 93-105.
    13. Goldstein,William M. & Hogarth,Robin M. (ed.), 1997. "Research on Judgment and Decision Making," Cambridge Books, Cambridge University Press, number 9780521483346.
    14. David J. Spiegelhalter & Laurence S. Freedman & Mahesh K. B. Parmar, 1994. "Bayesian Approaches to Randomized Trials," Journal of the Royal Statistical Society Series A, Royal Statistical Society, vol. 157(3), pages 357-387, May.
    15. Stoye, Jörg, 2012. "Minimax regret treatment choice with covariates or with limited validity of experiments," Journal of Econometrics, Elsevier, vol. 166(1), pages 138-156.
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    Cited by:

    1. Jason Abaluck & Leila Agha & David C. Chan Jr & Daniel Singer & Diana Zhu, 2020. "Fixing Misallocation with Guidelines: Awareness vs. Adherence," NBER Working Papers 27467, National Bureau of Economic Research, Inc.
    2. Lydiksen, Nis & Greve, Jane & Jakobsen, Marie & Kristensen, Søren Rud, 2021. "Using national clinical guidelines to reduce practice variation – the case of Denmark," Health Policy, Elsevier, vol. 125(6), pages 793-798.
    3. Ashesh Rambachan, 2022. "Identifying Prediction Mistakes in Observational Data," NBER Chapters, in: Economics of Artificial Intelligence, National Bureau of Economic Research, Inc.

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    More about this item

    JEL classification:

    • C4 - Mathematical and Quantitative Methods - - Econometric and Statistical Methods: Special Topics
    • D81 - Microeconomics - - Information, Knowledge, and Uncertainty - - - Criteria for Decision-Making under Risk and Uncertainty
    • I10 - Health, Education, and Welfare - - Health - - - General

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