(credit: H. Uechi)

Personal framing

We have more power over how we make choices and how we feel than we may realize

Koen Smets
5 min readApr 20, 2018

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Imagine you are an oncologist, and you discuss a course of action with a lung cancer patient. There are two possibilities: surgery and radiotherapy. You know that 90 out of every 100 people will survive the operation, 68 will be alive one year after the operation, and 34 will be alive at the end of five years. With radiotherapy, all 100 patients survive the treatment, 77 will be alive one year later, and 22 will be alive after five years. Which option would you recommend?

Now consider the information was presented differently. Of 100 patients undergoing surgery, 10 will die during the treatment, 32 will have died within one year, and at the end of five years, 66 patients will have died. With radiotherapy, none of the patients will die during the treatment, 23 will die within one year, and after five years 78 will have died. Would you make the same choice?

Both versions were part of a questionnaire from a study by Barbara McNeil, Stephen Pauker and Amos Tversky into the framing of medical decisions. Among students at Harvard Medical School and Hebrew University in Jerusalem, one group was given the first set of descriptions, and a second group got to see the alternative set. In the first case, 18% of the of the respondents favoured radiation therapy over surgery; in the second case, that proportion was 47%.

You will probably have spotted that both the survival and the mortality formulation contained exactly the same facts. Yet the mortality data in the second set appear to “have more impact than the survival data.” Framing clearly matters.

Reframing the dilemma

Such choices of life and death are not common in the lives of most of us, thankfully. But we can sometimes find it hard to make a rational decision between two possibilities. It occurred to me that framing can help here when, a while ago, a friend travelling back from Tokyo to London tweeted about a dilemma. Was it worth paying something like $1000 for a business class upgrade, and fly in comfort after a week’s hard work? He could have agonized about how long the effect of spending $1000 would have lasted, or considered the numerous alternative uses there were for the…

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Koen Smets

Accidental behavioural economist in search of wisdom. Uses insights from (behavioural) economics in organization development. On Twitter as @koenfucius