ObjectiveTo determine the attitudes of physicians and trainees in regard to the roles of both cost-effectiveness and equity in clinical decision making.DesignIn this cross-sectional study, electronic surveys containing a hypothetical decision-making scenario were sent to medical professionals to select between two colon cancer screening tests for a population.SettingThree Greater Boston academic medical institutions: Tufts University School of Medicine, Tufts Medical Centre and Lahey Hospital and Medical Centre.Participants819 medical students, 497 residents-in-training and 671 practising physicians were contacted electronically using institutional and organisational directories.Main outcome(s) and measure(s)Stratified opinions of medical providers and trainee subgroups regarding cost-effectiveness and equity.ResultsA total of 881 respondents comprising 512 medical students, 133 medical residents-in-training and 236 practising physicians completed the survey (total response rate 44.3%). Thirty-six per cent of medical students, 44% of residents-in-training and 53% of practising physicians favoured the less effective and more equitable screening test. Residents-in-training (OR 1.49, CI 1.01 to 2.21; p=0.044) and practising physicians (OR 2.12, CI 1.54 to 2.92; p<0.001) were more likely to favour the equitable option compared with medical students. Moreover, female responders across all three cohorts favoured the more equitable screening test to a greater degree than did male responders (OR 1.70, CI 1.29 to 2.24; p<0.001).ConclusionsCost-effectiveness analysis does not accurately reflect the importance that medical professionals place on equity. Among medical professionals, practising physicians appear to be more egalitarian than residents-in-training, while medical students appear to be most utilitarian and cost-effective. Meanwhile, female respondents in all three cohorts favoured the more equitable option to a greater degree than their male counterparts. Healthcare policies that trade off equity in favour of cost-effectiveness may be unacceptable to many medical professionals, especially practising physicians and women.

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

The Boston Marathon is the most popular marathon in the New England region and attracts some of the most qualified athletes participating from the United States and abroad. The race occurs in April, a month in the northeast characterized by unpredictable weather. While there are a number of well described weather-related medical complications that occur during exercise, less is known about noncardiogenic pulmonary edema (NCPE) in marathon runners, a condition that most physician are unfamiliar with. This phenomenon has been described in the literature as a complication of severe hyponatremia and cerebral edema. Here, we describe the case of a healthy athlete who took part in the Boston Marathon in 2018 and presented afterwards with hypothermia and NCPE. We also review the normal cardiopulmonary physiology along with the physiological changes and external factors impacting the respiratory system during exercise. The combination of significant physical exertion, cold and rainy weather and subsequent hypothermia, perhaps along with other less understood factors may have increased the permeability of his lungs and caused NCPE.

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