Society for Medical Decision Making

By Bob Beck, MD; United States

On behalf of the Board of Directors I write with sadness to note the passing of J. Sanford “Sandy” Schwartz, M.D. on June 24, 2021. Sandy was a giant in our field, making seminal contributions in several areas within medical decision making. He received an A.B. in History from the University of Rochester in 1970, and his medical doctorate from the University of Pennsylvania in 1974, where he subsequently trained in Internal Medicine and spent his entire career. At the time of his passing, Dr. Schwartz was the Leon Hess Professor of Medicine, Health Management and Economics at the University of Pennsylvania Perelman School of Medicine and the Wharton School, Senior Fellow at Penn’s Leonard Davis Institute (LDI), and Senior Scholar at the Center for Clinical Epidemiology and Biostatistics. He served as the LDI's Executive Director from 1989–1998.

Sandy focused on health services research, policy issues, as well as cost-effectiveness analysis and general topics in clinical decision making. He advised federal and international agencies, corporations, regulatory agencies, and numerous nonprofit organizations. In service to the field, Sandy was the founding Director of the American College of Physicians’ Clinical Efficacy Assessment Project, founding editor of the American Journal of Managed Care, and had editorial positions with the Journal of General Internal Medicine and Medical Decision Making. He was elected to the National Academy of Medicine in 2008 and served the Academy in numerous ways during his tenure.

For the Society, Sandy served as a two-year Trustee from 1984-86 and the three-year Presidential term from 1987-90. He received the Society’s highest award for Career Achievement in 2010, and the John M. Eisenberg Award for Practical Applications of Medical Decision Making in 2014.

To many students, trainees, and younger members of the Society, Sandy was a mentor, teacher, and source of academic and professional encouragement. Many of today’s leaders in health services research and decision science benefited from his active help. For me, he was a warm and gracious colleague, always learning and quick with wise ideas and suggestions.

A fuller In Memoriam is forthcoming in an SMDM publication. This issue of the Newsletter offers other tributes to Sandy. We will all miss him terribly.

By Donald Berwick, MD; United States

I find it impossible to think of Sandy Schwartz without smiling. In decades of work in clinical care, academic medicine, and public policy, I have encountered no other colleague with a combination of grace, humor, and warmth equal to his. I recall not a moment of arrogance, not a hint of win-lose stakes, and, incredibly, not a word of meanness toward anyone else. His jokes were endless (and very funny) but always gentle. He was a true scholar, immensely perceptive, with enormous curiosity and a bias toward fresh thinking. But, notwithstanding my boundless respect for Sandy, the professional, my memory returns over and over again to a different theme: that Sandy was fun to know and fun to be with – a devoted friend and an encouraging presence. That kind of comfort – optimism, humor, and warmth – in our troubled world may seem like a superficiality, but it is not. It is at the core of what made Sandy so special, such a source of good will, and such a gift to us all.  

By Arthur Elstein, PhD; United States

Sandy and I met at the very first SMDM meeting in 1978. Later, in Spring 1984, he was an active and constructive participant in a seminar I convened on clinical judgment and decision making, while on a short sabbatical at Penn. Sandy had many outstanding qualities. He was outstanding for informality.  In a group of men who wore coats and ties at SMDM meetings, he memorably appeared with sleeves rolled up and without a tie.  Sandy had a keen intelligence and a very good heart. He will be sorely missed.

By Marilyn Schapira, MD, MPH; United States

Sandy and Sue Schwartz are some of my dearest friends. I had known and looked up to Sandy since my earliest days in SMDM but first got to know Sandy and Sue on a more personal level during our European SMDM meeting in Tyrol, Austria, in 2010. I remember us all enjoying Austrian beer and asparagus salads (it was asparagus season) in a lovely indoor-outdoor local restaurant. When I moved to Philadelphia in 2012, Sue and Sandy warmly welcomed me to the community and we have been close friends ever since. It’s hard to convey how closely connected people from this community are to Sandy, Sue, and their family. He was known for valuing everyone’s perspective and ideas, going out of his way to spend time with people (he commonly would ask mentees to join him for a car ride while running errands to discuss papers, grants, and family), his generosity to the community, and how humble he was about his accomplishments. He was a special person and we were so lucky to have him as a leader, colleague, mentor and friend within SMDM.

By Hal Sox, MD; United States

Fine mind, big heart. Sandy always understood that, in the end, it’s about everyone else. It’s a lesson usually learned late in life, but he was always a quick study. On the other hand, he had a just in time approach to deadlines. The older among us share the memory of Sandy, late for his presentation at a scientific meeting, entering the room as the discussion period for the preceding talk was winding down, thrusting his slides into the hands of the projectionist, and taking his seat just in time to stand back up, walk to the podium, and deliver a brilliant talk.

By Heather Taffet Gold, PhD; United States

I was terribly sad to hear of Sandy Schwartz’s passing in late June. I often referred to him as my “work uncle” – he was a kind and generous mentor and always a cheerleader, for which I am ever grateful.

I joined SMDM as a doctoral student and attended my first meeting in 1998, followed by my first poster presentation in 1999, where Sandy came up and discussed the study with me. I reflect back now and realize he was probably a judge for the Lee Lusted student prize, which used to be more secretive, but then I was merely flattered he was paying any attention to my work, a class project. In 2000, I had my first oral presentation accepted and was quite anxious. Early in the meeting, Sandy and I recognized each other and started talking; I told him how nervous I was, and he suggested I run through the presentation with him. We found a quiet corner in that Cincinnati, Ohio, hotel, and with a printout of my slides, I practiced the talk. The study focused on problems I had identified with how the DEALE (declining exponential approximation of life expectancy) “behaved” in low mortality scenarios, and I cited the original work by Beck and colleagues.* I still remember Sandy saying, “Bob Beck will be in the audience; you have to be careful how you talk about this.” Sandy helped me with the language to ensure I was constructive without sounding critical. I will never forget the time he spent with me as a new and very junior colleague (still a student!), with such thoughtfulness and generosity.

Our interactions continued over the years at meetings and beyond. As I matured as a researcher, Sandy invited me to Penn to give a seminar and meet his colleagues to gain deeper insights for a grant proposal I was developing. He knew I didn’t have access to the experts I needed, and he created and facilitated the networking that helped me succeed. He often would ask to read my grant critiques and provide additional feedback. We also worked together on the 2008 Philadelphia SMDM meeting, where he was meeting co-chair and I was scientific review co-chair. He actually drove me bonkers with his “interesting” organizational skills, but by then I had come to know what to expect: Sandy’s heart was big, and he always took on too much.

Sandy and I had lunch together when he visited New York, and as I transitioned to New York University School of Medicine in 2011, Sandy insisted I have a meeting with his friend, the chair of the Department of Medicine at NYU. Professional networking truly was Sandy’s forte, and no one was too important for an introduction.

One final treasured memory about Sandy was that he always asked after my husband and kids and even remembered their names. He didn’t expect that my life was compartmentalized into “work” and “non-work”; he knew both were important. I truly appreciated our sweet and thoughtful conversations touched with his humor. (Sandy always had a joke at the ready.) Sandy’s wisdom, guidance, generous spirit, and caring approach will stick with me as a model and a buoy.

*Beck JR, Kassirer JP, Pauker SG. A convenient approximation of life expectancy (the "DEALE"). I. Validation of the method. Am J Med. 1982 Dec;73(6):883-8. doi: 10.1016/0002-9343(82)90786-0. https://pubmed.ncbi.nlm.nih.gov/7148881/

Beck JR, Pauker SG, Gottlieb JE, Klein K, Kassirer JP. A convenient approximation of life expectancy (the "DEALE"). II. Use in medical decision-making. Am J Med. 1982 Dec;73(6):889-97. doi: 10.1016/0002-9343(82)90787-2. https://pubmed.ncbi.nlm.nih.gov/6983298/

By Joel Tsevat, MD, MPH; United States

If I had to describe Sandy in a few words, they would certainly include “great mentor,” “mensch,” “all-around great guy,” and “very invested in SMDM.” But a few words wouldn’t do him justice. He will be sorely missed.

By Milton Weinstein, PhD; United States

I knew Sandy since the early days of SMDM in the early 1980s, when he was a student/trainee of John Eisenberg’s at Penn. Four things about Sandy stand out in my memory. First, everybody has experienced or observed his friendly, welcoming demeanor toward all SMDM members, from seniors and contemporaries to students and trainees. He was everybody’s friend and colleague. Second, he was passionately committed to making health better through better policies. He served on committees and panels, authored position papers, and did everything in his power to influence government and the medical profession to do the right thing. Third, he was a champion of decision science and evidence-based analysis, not only in his scholarly work but also in his service to medicine and public policy. Finally, he was committed to his trainees and took pride in their accomplishments. For me, seeing Sandy at SMDM meetings has been a highlight of those meetings for me. I will miss him.