Benjamin Djulbegovic is an American physician-scientist whose academic and research focus revolves around optimizing clinical research and the practice of medicine by comprehending the nature of medical evidence and decision-making. In his work, he has integrated concepts from evidence-based medicine (EBM), predictive analytics, health outcomes research, and the decision sciences.

Biography Djulbegovic was born in Sarajevo, Bosnia and Herzegovina, Yugoslavia. He was trained both in basic sciences and clinical medicine. In 1983, Djulbegovic earned his medical degree and PhD in biomedical sciences from the University of Sarajevo. He earned an M.S. degree in biophysics from the University of Zagreb (1983–1985) and was trained in internal medicine and hematology at the University of Sarajevo, Belgrade, and Christie Hospital, Manchester, England. Subsequently, he completed his residency in internal medicine and a fellowship in hematology and medical oncology at the University of Louisville School of Medicine in the United States (1988–1991).Djulbegovic, B. Board Certifications: Hematology and Internal Medicine, https://www.abim.org/verify-physician?type=name&ln=Djulbegovic&fn=Benjamin Djulbegovic then joined the University of Louisville as an assistant (and later, associate) professor (1996–1998). In 1998 he moved to the H. Lee Moffitt Cancer Center and the University of South Florida (USF), where he became a full professor.

During his tenure with the H. Lee Moffitt Cancer Center and the University of South Florida, where he was appointed as a Distinguished Professor of the university (2010–2017),2010 Distinguished USF Health Professors, Morsani College of Medicine, Ben Djulbegovic, MD, ScD https://health.usf.edu/facultyaffairs/DistinguishedProf he founded the Center for Evidence-Based Medicine and the Health Outcomes Research CenterThomas Chalmers Award in Evidence-Based Medicine Goes To USF Health.https://hscweb3.hsc.usf.edu/awardsblog/2012/03/04/thomas-chalmers-award-in-evidence-based-medicine-goes-to-usf-health as a foundation for later development of core in research methods and biostatistics at USF. At USF he also served as the associate dean for clinical research (2012–2013).Clinical Trials: About Half of New Treatments Perform Better Than Existing Ones - USF Health News https://hscweb3.hsc.usf.edu/blog/2012/10/17/clinical-trials-about-half-of-new-treatments-perform-better-than-existing-ones/

From 2017 to 2023, he served as a professor at the City of Hope National Medical Center, Beckman Research Institute, CA. Since 2023, Djulbegovic has served as the director of the Hematology Stewardship Program at the Medical University of South Carolina in Charleston, SC and as an affiliate member of the Meta-Research Innovation Center at Stanford University. , his body of work had received over 52k citations with an h-index of 78. He has authored over 400 papers in peer-reviewed journals, four books, over 200 abstracts, book chapters, and editorials.

Linking evidence-based medicine with decision-making Djulbegovic's work includes the coherent linkage of evidence-based medicine (EBM) to formal systems in decision sciences. His collaboration with colleague Iztok Hozo summarized their previous work in the book "Threshold Models For Decision-Making in Clinical Medicine," published in 2023. This work illustrates the connection between EBM and structured frameworks in the decision sciences in accordance with cited peer-reviewed work.

Djulbegovic has argued that underuse and overuse observed in clinical practice is a consequence of a relationship between scientific evidence (that exists on a continuum of credibility) and decision-making (that is, categorical, yes/no exercises, as decisions, have to be made) that creates the Sorites paradox. At which point is the probability of disease or outcomes sufficiently high or low enough for us to act?

He and Hozo proposed threshold models as a rational (and pragmatic) way to address the Sorites paradox. Djulbegovic et al. have also posited that the appropriateness of care, whether underuse or overuse, depends on the choice of a decision-theoretical framework.

He contributed to understanding of the processes of evidence-based clinical practice guidelines. Medical Guidelines are widely considered as essential vehicles for improving persistently suboptimal healthcare. However, because guidelines have their problems, Djulbegovic has also argued that further improvement of guidelines processes is only possible within a decision-analytical framework. In particular, he has argued that clinical practice guidelines can be improved if they are translated into clinical pathways and fast-and-frugal trees within the framework of threshold decision models to develop more individualized patient care.

These principles were translated into the systematic application of the science of EBM and decision analysis in the fields of hematologyDjulbegovic B and Beganovic S, Reasoning and Decision Making in Hematology, 1st ed. 1992, Churchill Livingstone, and oncology,Djulbegovic B and Sullivan M, Decision Making in Oncology: Evidence-Based Management, 1st ed. 1997, Churchill Livingstone, The work was reviewed in hematology and oncology by the Journal of the National Cancer Institute.

Law of therapeutic discoveries Through the analysis of the role of uncertainty in medicine and the clinical equipoise principle, Djulbegovic introduced the concept of "the law of therapeutic discovery." This theory predicts a 50-70% success rate in discovering new treatments in randomized clinical trials (RCT) based on the foundational ethical and scientific justification for conducting trials in humans.

This principle - which links key precepts of moral philosophy with theories of rational decision-making is further explained and demonstrated in a BMJ manuscript that asks and then answers "Are experimental treatments for cancer in children superior to established treatments?" Furthermore, Djulbegovic communicates how uncertainty and a loss of equipoise can fuel misinformation in patient populations.

Rational clinical decision-making and development of "acceptable regret" theory Together with Hozo, Djulbegovic developed the decision-theoretical concept of "acceptable regret." This concept allows clinicians, scientists, and policymakers to determine when they can accept findings, even if proven wrong later. "Acceptable regret" has been used to explain both underuse and overuse in the delivery of health services, offering insights into the decision-making process of satisficing in clinical practice. The concept is held to shed light on why most people, whether patients or relatives caring for patients at the end-of-life require almost absolute certainty of imminent death before accepting referrals to hospice.

Dramatic works

Djulbegovic translated his scientific writings on uncertainty into a play titled "An Impossible Decision: The Life Interrupted by Uncertainty." Using the Socratic dialogue and playwright format, he illustrates the applicability of theoretical concepts of the science of uncertainty to real-life decision-making and how they matter to all of us individually and collectively.

Awards and honors

In his early career, he was awarded the Thomas C. Chalmers Award for empirical verification of the uncertainty (equipoise) principle (1999). His group's work was also recognized with a second Chalmers award in 2012.Djulbegovic B, Lacevic M, Lyman GH. Empirical verification of the uncertainty principle in conducting randomized trials. Proceedings of the 7th Cochrane Colloquium, 1999 https://community.cochrane.org/news/prizes-and-awards/thomas-c-chalmers-award

In 2017 he received an award for Excellence In Person Centered Healthcare at the Fourth Annual Conference of the European Society for Person Centered Healthcare (ESPCH4), Westminster Cathedral Hall, London.

Selected publications

References