1. 2016 Draft USPSTF Recommendations for Aspirin to Prevent Cardiovascular Disease and Cancer in Adults Ages 60-69 Years The decision to use low-dose aspirin to prevent CVD and colorectal cancer in adults ages 60-69 years who have a > 10% 10 year CVD risk should be an individual one. Persons who are not at increased risk for bleeding, have a life expectancy of at least 10 years, and are willing to take low dose aspirin for at least 10 years are more likely to benefit. Persons who place a higher value on the potential benefits than the potential losses may choose to use low-dose aspirin.”

2. * Kahneman, D. Thinking, Fast and Slow. Farrar, Straus and Giroux, NY 2011, p. 281 – 3.

3. Prospect Theory* You are offered a gamble on the toss of a coin. If the coin shows tails, you lose $100. If the coin shows heads, you win $150. Is this gamble attractive? Would you accept it? * Kahneman, D. Thinking, Fast and Slow. Farrar, Straus and Giroux, NY 2011, p. 281 – 3.

4. Use of Low-Dose Aspirin in Persons Deemed Appropriate by the USPSTF Is this simply a matter of “getting the word out?”  Levels of appropriate use in secondary prevention >> primary prevention  Considerable disparities in rates by race, sex, socioeconomic status despite universal access and cost. Can this be explained in part by Prospect Theory and loss aversion?  Patients advised by media or care providers  Care providers

5. Prospect Theory* Pertains to decision making relative to choices which could give gains or losses.  Evaluation is relative to a reference point (e.g., “current health risk”).  Has diminishing sensitivity to both psychological value and magnitude of changes/losses.  Identifies loss aversion as potential losses carry greater psychological impacts than do potential gains. * Kahneman, D. Thinking, Fast and Slow. Farrar, Straus and Giroux, NY 2011, p. 281 – 3.