Quality Adjusted Life Years and the Neuroscience of Fairness

This month we published the first ever fMRI brain imaging study of health care rationing decision making 


decision making screens

Health care funders around the world have to make difficult moral decisions to allocate limited money to treat various medical conditions in different groups of patients. For example whether or not to support funding for expensive new drug treatments for a group of cancer patients with low chance of survival relative to a drug that will benefit a group with a higher chance of survival.  A commonly used framework on which these decisions can be based are Quality Adjusted Life Years or “QALYs”. This system is based on so-called utilitarian decision making principles, which prioritize choices that deliver the maximum benefit to the greatest number of people. The problem with QALYs  is that decisions based on this approach are often viewed negatively by members of the general public. People instead believe that everybody has a “right” to receive medical care and anything that violates this principle is unfair and immoral.

Consistent with previous work, when asked to judge the “fairness” of various scenarios depicting a split between different social groups our participants judged unequal division of funding as “unfair”, even when principles of QALY might indicate otherwise. Interestingly brain regions linked to emotion as well as cognitive processes were active during decision making. Unequal splits of resources for medical care produced activity in the anterior insula, a region often associated with social / moral disgust (see earlier posts on social norms and eating disorders). Further, under conditions where participants were prepared to judge unequal splits as fair, more activity was seen in the inferior frontal cortex, a region activated when humans inhibit a strong response impulse.

The results represent a preliminary first step for cognitive neuroscience into the field of health economics and the paper is careful to avoid over interpreting the findings and applying them to real situations outside the scanner. But the findings are consistent with a bigger idea that humans have two decision making systems, one cognitive and one more emotional / instinctive. Given enough information people may be more inclined to support healthcare decisions based on QALYs, but this requires cognitive effort to over-ride a more emotion based bias towards absolute equality and universal rights.

The paper is out  ipic2n the June edition of the Journal of Neuroscience Psychology and Economics. The research was carried out in collaboration with Prof. Paul Anand ( Open University and Health Economics Research Centre at the University of Oxford), Lisa Smith (Flinders University Austrailia) and the Exeter Magnetic Resonance Research Centre. A pre-print of the paper is available via the Lincoln Repository website.

Lincoln Triathlon for Parkinsons UK

In a couple of weeks time I’m aiming to complete the David Lloyd Lincoln Sprint Triathlon in benefit of Parkinsons UK. You can sponsor me here

Much of my published research over the years has looked at how  eye movements are affected in Parkinsons during cognitively PDdemanding tasks such as problem solving, rule learning and task switching (see earlier post). In the long term its possible my research could help to develop tests to improve earlier detection of the condition. But what research papers can’t get across is what amazingly nice people Parkinsons patients are  and how positive they are about helping with research.

Because of this I wanted to make at least a token effort to raise awareness and provide a direct benefit by doing my Triathlon in aid of Parkinsons UK.

Eye movements in the real world


We currently have a fully funded studentship opportunity available to examine how we direct attention to social cues in the real world. Supervised by Dr Frouke Hermens and myself the project will involve using a mobile eye tracking system. The work builds on earlier work by Frouke, myself and my former PhD student Nicola Gregory (now at Bournemouth) looking at how socio-biological cues such as eye gaze direction and pointing finger cues direct attention in an automatic way.


See here for more details of the project and earlier posts on my work with Nicola on socio-biological cueing here


“EyeLander” game for children with VI now available!

EyelandFor the last 2 years I have been working with the WESC Foundation in Exeter to develop a computer game to  improve vision in children and young people with partial visual loss. In EyeLander you play the role of a character (The “EyeLander”) who must escape from an island using her visual skills. You have to make your way through a series of challenges to escape the erupting volcano, including dodging lava, an angry cow and a giant laughing baby! The only way to get through them to your boat is to find various coloured target shapes hidden amongst distracting items on the screen.

Although based closely on visual search training that has been shown to be effective in adults with hemianopia (see earlier post), EyeLander is unique in that is has been developed in collaboration with children at WESC and social computing researchers from Lincoln’s Computer Science department, adopting a user centred design approach. We believe this will make visual search training more effective and fun for children and even adults with visual field loss. angry baby

We will be evaluating the effectiveness of the game over the next few months and are interested in hearing from you if you suffer from any form of partial visual loss and would be willing to take part in the evaluation. We are also seeking involvement from children in the South West with  normal vision to take part in the research by playing the game and being an EyeLander!

Please contact myself (tlhodgson@lincoln.ac.uk) or Jonathan Waddington (JWaddington@wescfoundation.ac.uk tel:01392 454200) if you would like to know more or take part in the research. 


A Rewarding Summer of Eye movement Research

Reward and risk on blue road sign with blue sky The Lincoln Eyelink Lab (a.k.a. Lab E1) promises to be a busy place this summer. Undergraduate Research Opportunities Scheme (UROS) students Daniel Richardson and Jade Pickering will be working in the lab between July and August alongside two eye movement researchers from Turkey.

 Daniel Richardson is examining the “neuroeconomics” of reward and eye movements. Together we are developing a task in which participants learn mappings between target stimuli and points rewards. We are interested in whether the learned reward value of stimuli might subtley modify the kinematics (speed and accuracy) of eye movements made towards them.

 Jade Pickering will be assisting with  my investigations of oculomotor and cognitive studies in people with Parkinsons later in the summer as well as collecting some pilot data for the GPSAC project using the Ober saccadometer device.

PhD research student Murat Ozger will be continuing to develop his work on visual attention and eye movements in Crime Scene Investigation settings (see YouTube video).eye

We are also joined by visiting researcher Aycem Ozturk (Dokus Eylul University, Izmir, Turkey) who is in the UK to learn about the Eyelink 1000 system and to further develop her research into oculomotor function in Parkinsons and dementia.

It is exciting for me to be working in such a busy team of researchers this year and I am sure it will be a rewarding summer!