# Lecture 2: Framing effect

Tversky and Kahneman found that the scenario of decision-making also plays a critical role.
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The concepts of decision weight and value highlight the fact that different decision-makers would show different preferences for the same set of options. Amazingly, Tversky and Kahneman found that the scenario of decision-making also plays a critical role. The decision frame, i.e., how questions and options are described, is another factor affecting our decisions. Here is a ‘case study’ to illustrate this. Assuming that you were the city major and a shipwreck just happened. There are two plans for rescue. In Plan A, exactly 200 passengers will be rescued. In Plan B, perhaps a new but less reliable technology is introduced, all the passengers will be rescued or none of them will be rescued. Which plan would you prefer to take?
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Obviously, these two plans are equivalent if we calculate the expected value for human life – that would be what a computer would do. But as human beings, we prefer one plan to another. In fact, many experiments show that decision-makers would prefer Plan A, which represent a ‘sure’ outcome. That means the result is certain, 200 will be rescued. Plan B may be too risky to some people – there are two-thirds the chance that no one will be rescued. Now imagine another scenario, in which the options are framed in a different way. Now in Plan A, 400 passengers will die. In Plan B, with good luck, all of them won’t die. But with bad luck, again, all of them will die.
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In this ‘darker’ scenario, many experiments show that decision-makers would prefer Plan B to Plan A. In other words, the preference from a ‘sure’ plan to a ‘risky’ plan is not fixed. People may change their preferences simply because the options are presented in different frames. In this case, people favour a sure option when they consider how to rescue life. And they favour a risky option when they consider how many people will die.
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And here comes a critical conclusion of making a decision under risk: people have different tendencies of taking a risk. When it comes to gain, a sure option, such as wining 90$for certain, is preferred. In this condition, we present the tendency of risk aversion. Another option is less attractive because there would be a 10% chance to win nothing. In contrast, when the decision frame is changed to a different set, our tendency may change. For example, now we consider how to avoid loss. Here a sure option is less attractive because we are fated to lose 90$. In contrast, the ‘risky’ option seems more attractive – after all, there is still a 10% chance that we won’t lose anything!
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It should be noted that such a tendency also reflects the more complicated cognitive and emotional process. Risk aversion may be associated with the fear of potential loss, and risk-seeking behaviour may reflect a brighter ‘hope’ that we can avoid all loss. Interestingly, the prediction from theories does not go too far from what patients would do. Patients have different tendencies to take a risk, which is a fundamental element of all medical decisions. And we need to keep in mind that the way to present the options may influence their decisions. I think this part of the class may be a little bit strange to you because it looks like we are having some lecture about economics.
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I am not an economist, but in my experience, dentists need to negotiate with patients for these decisions with uncertain outcomes all the time. A common problem for decision-making is we, as dental professionals, usually start from the hard evidence. For example, we describe the percentage of success rate and the degree of adverse effect, as estimated by academic journals, to patients. However, patients decisions are influenced by more factors, as described in the prospect theory. Some dentists may blame patients for their decisions as ‘irrational’ because these decisions do not meet with the calculation of numbers, as textbooks said. I hope you understand that there are great individual variations in making a medical decision, such as risk aversion and risk-seeking, among patients.

### The decision frame

Tversky and Kahneman found that the scenario of decision-making also plays a critical role. The decision frame shows us that how questions and options are described, is another factor affecting our decisions.

In this session, it seems like we talk more about economics rather than neuroscience. However, in our experience, dentists need to negotiate with patients for these decisions with uncertain outcomes all the time.

And a common problem for decision-making is we, as dental professionals, usually start from the hard evidence. However, patients’ decisions are influenced by more factors. They are not only based on the evidence you show them.

Over to you

Now it’s your turn to share with us, what will you do to make a hard decision by yourself? Would you like a piece of suggestion from others? And from who? Your dentists? How?