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.

Male gray treefrogs advertise for mates using calls that consist of a series of pulses. Pulse duration, interpulse interval, and pulse shape determine whether a call is recognized as a conspecific signal by females. Females use call rate and call pulse number to assess relative calling performance by males, and prefer males that display high calling efforts. However, within choruses call overlap among males and background noise can compromise the ability of females to detect and correctly interpret temporal information in calls. Phonotaxis tests using calls suffering from different patterns of overlap or with internal gaps were used to investigate specific consequences of interference and masking as well as mechanisms that might alleviate such problems. Our data indicate that females do not employ a process analogous to phonemic restoration to ‘‘fill in’’ missing call segments; however, if a sufficient percent of call elements fall within species-specific ranges, females may ignore call anomalies. Additional findings are generally consistent with those from a recent study on anuran auditory midbrain neurons that count and indicate that inappropriate pulse intervals can reset the pulse counting process. [Work supported by NSF and a Pace University Eugene M. Lang Research Fellowship.]