Author Archives: Terry

About Terry

I am a specialist in methodological issues (discrete choice modelling) and applied areas such as quality of life and end-of-life care. Specifically: I am a recognised world expert in best-worst scaling, with a particular interest in its use in health care and public policy. Together with the inventor, Jordan Louviere, and Anthony Marley, we are completing the definitive book explaining its use, to be published by Cambridge University Press in 2014. In the meantime a good introduction to the method is provided in my paper: Flynn TN. Valuing citizen and patient preferences in health: recent developments in three types of best-worst scaling. Expert Review of Pharmacoeconomics & Outcomes Research 2010; 10(3):259-267. It should be noted that maxdiff scaling and associated terms are incorrect, misleading and primarily used by marketing companies. I am also co-developer of the ICECAP-O instrument, together with Professor Joanna Coast at the University of Birmingham. I am a Senior Research Fellow at the Centre for the Study of Choice (CenSoC), at the University of Technology, Sydney, as Head of Social Policy and Economic Evaluation.

superhero movies

Been reading lists of “top tens” and suchlike. The ranking of the Superman films made me think and really, I mean really, realise why although I think Superman – The Movie is so spectacular (and on some days of the week would be placed at number one by me), the reason I have to place Superman II ahead of it (for all its flaws – largely related to the production fiascos about which you can google) is that despite the “super-kiss”, it doesn’t use a TOTAL DEUS EX MACHINA.

Superman I does with time travel. And I hate it when writers use that as a plot device to “undo a problem they got themselves into”. Of course the time travel thing was MEANT to be used in Superman II by Donner (which merely would have ruined S2 instead) – thus, although I retain huge respect for the man, and acknowledge he was treated badly when Warner Bros got cold feet about the “double movie deal” and made him use what he’d filmed (which was material from BOTH films) to make a coherent stand-alone first movie, I think the “Donner campaign” is misguided. Yes, the “Donner version of S2” has some sublime elements – it’s a crying shame that money meant that Superman regaining his powers was not done using the original filmed scene with Marlon Brando, and which is on google – it’s a tear-jerker) – but otherwise? I have to say that had the original plan been followed, Superman I would have been a great movie, but Superman II would have been ruined and “undone” everything from these first two movies, ready for a blank slate for future rehashes of plots/baddies etc. Which I really hate.

GLAD

I have signed up to the GLAD Study – the largest of its kind in mental health to try to understand associations between genes and depression/anxiety.

I am someone who professionally has been on the “other side of the fence” for decades – trying to recruit people, and the right type of people, to studies in attempts to help patients and further scientific knowledge. Thus I understand the need to sign up to studies, if one is eligible and I do so whenever appropriate.

I also have a very personal interest in the study – my mental health problems in recent years relating to anxiety and depression are no secret. I could probably write a patient’s guide on most antidepressants and types of talk therapy! I am in a relatively good place at the moment…..but I was only able to navigate the tortuous process of trying a multitude of treatments over a necessarily long period because I am self-employed and was always able to schedule my work in a manner that ensured I provided 100% in my work…..even though it often led to difficulties in the non-work arena.

Many people are not as fortunate – they have no flexibility in their life to undergo such tortuous “suck it and see” approaches to treatment. The GLAD study may ultimately make life easier for all of us – if we begin to understand what medications and other interventions are more or less likely to work in what patients, based on their genetic makeup, then much human misery may be avoided.

I have a purely personal desire, too, that some older treatments are rediscovered, along with the facts their side effect profiles are not half as bad as many young doctors have been taught!

Big bang theory fail

OK the Big Bang Theory is to finish. I enjoyed the first few seasons but like most/all sitcoms it became formulaic and I’m glad it is being put to bed.

Various hard-core internet nerds have given examples of where its claimed “devotion to detail” actually failed. I don’t generally get het up about these, but one enduring one irks me and I felt compelled to correct someone on YouTube – it concerns the iconic scene in Superman The Movie when Superman first reveals himself and saves Lois from the fall from the helicopter.

Unfortunately the BBT perpetuates the blatantly inaccurate meme that Lois would have died by hitting Superman’s arms at terminal velocity. Watch the bloody clip on YouTube! It is abundantly clear from watching the background lights of the Daily Planet building that Superman matched her rate of descent and caused her to decelerate….well above ground level…so as to gradually slow her and keep her alive. He then resumed upward flying to do the same with the helicopter.

Just another example of (predominantly) younger viewers perpetuating and sharing memes within 1 second without actually checking the original source material. Others have also debunked this silly meme.

Sheesh.

/oldgitmoment

bad academia

I’ve written before about some poor papers I’ve seen/reviewed/refereed in academia.

Unfortunately the problem is becoming worse not better. I recently read articles that showed absolutely no awareness of key articles – we are not talking articles that could legitimately be “missed” in a literature review because of issues regarding different terminology etc and being in unrelated disciplines. We’re talking articles that are:

  • In the same field or a a field that is now routinely scoured for info, being recognised as one which generates a lot of the major methodological developments
  • Open source so can be read by literally anyone
  • Co-authored by someone who would and should and have got a Nobel Prize, had there been one in his discipline….and who was (graciously) mentioned in the Nobel lecture of an Economist who *did* get the Prize but who recognised the theory had been proven elsewhere at least as early as in economics.

This begs the obvious question:

WHY DID THE AUTHORS IGNORE A PAPER THAT SAID EVERYTHING THEY SAY….AND SAID IT 10 YEARS AGO?

I’m afraid I have only two explanations:

  1. The authors deliberately ignored the key article, to justify their work to funders, or
  2. The authors are incompetent, missing an article that were a first year undergrad to miss in a summer dissertation, I’d have failed them instantly.

So, what is it?

I hesitate to harp on about my education, but sometimes you must call a spade a spade. I was taught economics, obtaining a 2.1 at Cambridge University where I was taught Marx, mathematical economics that went beyond what my MATHS friends were doing in their degree, high level statistics, and proper literature reviewing. The latter was reinforced and drummed into me in my MSc in Health Economics at York and PARTICULARLY during my PhD at Bristol in Social Medicine (specialising in medical statistics and health economics).

I taught med students….which was a horrifying experience in terms of realising how little they understood calculus (having supposedly got an A or maybe at worst B grade in maths A level). Now I won’t get preachy – stuff that was on the single maths syllabus from 1960 was on the further maths syllabus of my time (1990-1991). So I know A levels had already been dumbed down to some extent. But there’s a critical threshold, beyond which the candidate is, well, retarded…..sorry for un-PC term….but I’m fed up of excuses for these people. They get away with work that is no better than the “fake news” they excoriated in daily pollution of my Twitter Feed….and it has to stop.

Sorry, you’re shit. Your work is sub-standard and you shouldn’t, absolutely shouldn’t, be in academia. You’re simply not up to it.

And people wonder why I get angry at the rubbish I’ve had to read through for years; why I don’t do anything academic anymore. There are a few very talented groups who I exempt from the above – you know who you are.

Others – WHY are you doing what you are doing? How do you sleep at night?

twitter content

Just a note regarding my two twitter accounts (personal and work).

My personal account was clearly fairly full of followers who were:

  • No longer active on Twitter
  • Probably muting me as they weren’t interested in what I had to say on  that forum (but may well be friends/colleagues who otherwise got on with me and didn’t like to block me)
  • Clearly just there to get ideas from me with no intention of having any meaningful interaction
  • Any combination of the above

Thus I have:

  • Made my personal account private, leaving my work account public
  • Started a process of “soft-blocking” a large number of followers from my personal account that seem to fit one of more of the criteria above. FYI a soft-block on twitter simply removes that person from your follower list. If your account is public, they can (if they notice they are no longer following you) instantly re-follow you. If your account is private they must submit a new request to follow you and see your postings, thus giving you complete control over your follower list.

I haven’t done this to spite anyone – it is simply a way to move people who I believe would only consider engaging with me in a professional capacity, including collaboration or contracting me for work, to my work account – they can follow me there if they wish. Those that I am keeping as followers on my personal account can see my non-work related stuff, together with some work-related stuff that I think is important but which I feel uneasy about sharing “for free” with just anyone.

Anyone on my personal account who doesn’t like the tone/content should feel free to unfollow me there and follow my work account instead. I’ll continue to keep a close eye on the postings from followers of my personal account – particularly those from people I have not met in person or had an online working relationship with – to spot anyone I think should really be following my work account and I feel uncomfortable having access to my personal one. (You are more likely to fall into this category if you tweet or retweet nothing.)

I do find it ironic that I started this process shortly before “peak social media” seemed to become a media story – see this.

Anyway just as a reminder: tflynnhealth is my personal account and tfchoices is my work account.

 

Why I hate rebooted Trek

This is the copy of a reply I made to someone on YouTube regarding upcoming Season 2 of Star Trek Discovery. For the record I (with reservations) enjoyed the first season. But I recently discovered ‘The Expanse’ on Netflix and have been binge watching the first properly conceptualised, well-written sci-fi show which doesn’t assume an IQ of 80 since BSG (well, BSG until episode 5 of Season 3 – then it went downhill when it became clear Ron D Moore hadn’t thought through the full space opera’s conclusion).

Whilst recently discovering The Expanse and thinking it’s the best thing since (pre season 3) BSG, I think there are places for both “hard” sci-fi like The Expanse and “soft” sci-fi like Trek.

My issues are more to do with the pacing in newer Trek – work out the average length of a shot/scene compared to (for instance) ST2: The Wrath of Khan. STD has to some extent pandered to the people who have only a 7 second attention span, but I still think that on balance it’s good and deserves a second chance. The Kelvinverse movies on the other hand? After the this-is-not-really-a-khan-honestly abomination I am preserving my retinas and stomach contents – I didn’t watch the third and have no intention of watching any more reboot trash.

The Expanse shows how there still lots of us out here with a brain and an attention span. STD *could* cater to us…..but I fear in the end it’ll do a Kelvinverse on us.

Twitter cull

In case you have come here having noticed I have culled you from Twitter (i.e. I am no longer following you), there’s a very simple set of reasons:

(1) I am increasingly persuaded by the journalists who feel that social media is actually a parasite on their life;

(2) You don’t engage with me. Why bother to link in some way if you show no demonstrable interest in my work or interest in engaging with me?

If you were to say “OK I really don’t care about patient preferences, I wanna sell phones to people, can we work together?” ironically I’d probably listen. That’s honest, at least. Not my favourite use of choice experiments but hey, it pays the bills.

Top tip – if you are working in health and are really interested in what I do, please do two things:

(1) Read the book – a good friend who is very renowned in the field used to hate it that everyone quoted McFadden for Random Utility Theory yet their referencing showed clearly, and beyond any doubt, that they had NEVER ever read the key chapter. (Mea culpa here – I speed-read it and my page-referencing is a page off in some places. Sorry, But at least I know what he endorsed and didn’t. Plus quite a few of you don’t seem to know even that.)

(2) Present something actionable to me.

As Jay from the Inbetweeners would say “Simples!” (Though of course I don’t intentionally tell complete porkies all the rest of the time like his character does!)

So, just to round off – I have ideas….I have ideas that work and which made me money  already….interested?

semi-retiring from blogging

Unfortunately I shall be semi-retiring from blogging.

When I say “semi”, I mean that general discussions on my personal website and comment on my personal twitter account will become few and far between. I shall continue to make comments/blogs on my work account.

There are several, in some cases related, reasons:

(1) Standards of practice in DCEs are not improving in health. It’s profoundly depressing when you read a blog entry/article/op-ed that has you nodding fiercely – as just happened – and then you get to the central defence of the paper. And it involves a discrete choice experiment that has not followed proper practice and stands a non-trivial chance of being totally wrong.

(2) Standards of literature review are appalling and getting worse by the year. When I did my PhD you wouldn’t dream of submitting a paper that didn’t show awareness of the literature – particularly if key aspects of your design have been heavily criticised by others.

(3) I get the distinct impression “political arguments” are trumping “data”. This partly follows on from (2): it’s well-known and established why quota sampling is important in DCEs yet “population representative sampling” continues to be used as an “advantage” (ha!) of DCEs done in the field of QALY Decision-making.

If this makes no sense to you then can I respectfully suggest you need to go do some reading?

If you don’t know the finding (from the mid 1980s) that heteroscedasticity on the latent scale is a significant problem in terms of bias, and how it matters in QALY studies, then it makes me think you have a rather large hole in your statistical knowledge and worries me immensely.

I won’t name names, in the interests of discretion, but I’m tired of making this point year in year out, with no result (with the honorouble exception of the EuroQoL Foundation who funded a group I am part of to look at this)….and I showed it empirically in the BWS book. Please read the health chapters to understand this. I’m open to questions by email if you don’t understand the logic.

(4) I spent a lot of my own money showing how attitudes are related to preferences in terms of politics…..which got me zilch…..the media are lemmings….they’d rather all jump off the cliff together than report something different (and based on stronger assumptions) and risk being “the one who was wrong”. Again, lack of statistical training, noted already by people like Ben Goldacre.

So I’m afraid I’m a little tired of all this. I have a business to run. Parents to do a lot of stuff for.

I’m still here on email – ask me if you’re puzzled. I’m not trying to be obstructive here. But I need to concentrate on putting food on the table.

All the best,

Terry

Best-Worst voting the answer?

With the truly appalling outcomes for Labour and Lib Dems – compared to where they need to be to be competitive in the General Election in a few weeks – maybe it is time to start thinking about electoral reform again.

Let’s start with that old trope from the LibDems – “fair votes”. Kenneth Arrow got a Nobel prize for proving there’s no such thing. Stop using the term. You decide what are the key welfare criteria you want from your system, then you can choose a voting system that delivers those (and probably not the “unimportant criteria”).

Now, we know there is a strong desire in the UK to preserve the link between “an MP” and “a constituency”. Fair enough. But the Alternative Vote – defeated in the referendum a few years ago – is not the only, or indeed perhaps even best, replacement for first-past-the-post (FPTP)

Tony Marley – co-author on the BWS book with me – has written a lot about the maths behind voting systems. People don’t realise Best-Worst Scaling works as a voting system. Plus I reckon it’d be attractive in the UK.

Here’s an example of how it might work, and deliver a different outcome to that observed in the results just published in the Local Election for the TEES VALLEY.

FIRST ROUND RESULTS:

  • CON – 40,278
  • LAB – 39,797
  • LD – 12,550
  • UKIP – 9,475

SECOND ROUND RESULTS (TOP TWO GET 2nd PREFS):

  • CON – 48,578
  • LAB – 46,400

So what happened? It’s pretty obvious most UKIP 2nd prefs went Conservative – their boost is suspiciously close to the UKIP vote. Of course we know UKIP has also poached from Labour in LEAVE-dominated northern seats, but I doubt many “kippers” put LAB as 2nd pref.

Where are the rest of the 2nd prefs?

About 7,000 are missing in action. Maybe people just refused to put a 2nd preference or gave them to fringe parties.

But I bet they knew what party they hated most.

Here’s how it might have played out under BWS:

  • LAB and LD voters encouraged to put Conservatives as “least”
  • UKIP put Labour (primarily) as “least” – some will put LD
  • CON put LAB as “least”

Result:

  • CON “lose” around 52,000 (LAB/LD) votes
  • LAB “lose” around 50,000 (CON/UKIP) votes

LIBDEM gain – or, if UKIP and some CON voters hate the LDs sufficiently (for their pro-Europe stance) even more than they hate Labour, then the “least” Labour vote leaves their net total beating the LIBDEMs. Either way the Conservatives don’t win – the UKIP/Conservative vote simply isn’t enough to offset both Labour and the LDs.

Of course with turnout around 21% a LOT more potential votes are up for grabs if people are energised to believe their vote(s) matter.

Worth thinking about.

 

 

BREXIT survey stuff on work account

Just a reminder that the results of my Best-Worst Scaling survey which showed what would happen if we could know the (LEAVE/REMAIN) view of every eligible voter in the UK is on my work account.

Most follow-up – regional variation, recommendations as to which type of BREXIT are preferred by whom, how 8% of that 28% who never turned out to vote could have held the key to everything – will be on that account too.

Some interesting observations from the raw data – and remember we can look at an individual’s responses here, because BWS gave us 10 data points to estimate 5 parameters:

  • The East Midlands, although heavily LEAVE, skews quite heavily toward a different type of BREXIT to other LEAVE regions.
  • The strong preference for free trade is simply not there….it has shifted – VERY heavily – toward the free movement of people throughout Europe. This “strong positive liking of immigration” is visible nowhere else. The non-English countries/principalities (Wales, Northern Ireland and Scotland) have a broadly neutral view on immigration. The non East-Midlands part of England strongly dislikes it
  • East Midlanders also have a strong antipathy toward several key aspects of the EU – in fact the pattern of their dislikes looks remarkably consistent with a “Swiss form of BREXIT” – one of the so-called “soft” BREXIT options.
  • They also are the region which loathes the EU budget contribution the most.
  • Their results form a remarkably realistic view, compared to some other segments of British society: they (we – am a Nottinghamian) seem quite happy to sacrifice elements of the single market and the customs union, plus we’ll adopt a constructive view on immigration with our European neighbours if it means we “get some money back”. We’ll also compromise on free trade quite happily.

So what gives? Has everyone round here had some secret training in Ricardo’s work, thus recognising when free trade is not welfare-enhancing?