Tag Archives: qualitative research

model disclosure

This post regards a twitter post with an interesting poll and discussion initiated by Chris Carswell (editor of Pharmacoeconomics and The Patient) and twitter handle @PECjournal on whether a statement should be added to a paper to the effect that the authors’ model, when requested, was not submitted for peer review.

I abstained, saying I think a statement should be made if it’s a “traditional” decision analytic/similar CEA/CUA but I personally don’t favour it for DCEs.

The two counter-arguments made were that:

  1. Proprietary models go against the spirit of transparency that is increasingly demanded, &
  2. My point that model selection for DCEs being part art is similar to that used in qualitative research but qualitative researchers still have to submit discussion guides/full survey.

I do acknowledge both points, but my responses would be as follows:

(1) Proprietary software is routinely used to generate designs and (particularly) to analyse results of economic and other models: we’re getting into the nitty-gritty of the likelihood maximisation routine used (EM algorithm/other etc), starting value routines used internally by the stats program, etc. The ultimate black box is the stuff that does everything for the novice/inexperienced DCE researcher, mentioning no names 😉

Now, that doesn’t make things right, but it does mean that unless the researcher has the full code for everything from DCE design to model selection, or can reference it all for reviewers, I don’t think picking on just the DCE model selection issue is fair.

(2) I have no objections to submitting the design of the survey – when I was a reviewer, most fatal errors were made in the design and take the view that no DCE can be properly reviewed without access to the design by reviewers. (Another reason why authors might like to rethink if they are going to use “adaptive conjoint” – are they going to provide the design administered to every respondent? Haha, thought not, and if they do, will reviewers check through such a model, involving programming it in their software. Haha, thought not.) I myself also provide details of the main and secondary analyses I conducted. These can all be reproduced by reviewers, if they want to. The difficulty – and I believe, from my (far more limited, I acknowledge) experience/observation of analysis of qualitative data that it’s the same there – is that value judgments are made: e.g. “have we really reached saturation?” etc. For the reviewer it comes down to “in my experience, do I agree with this?”

And, unfortunately, in my experience in academia, too few peers had sufficient experience – and I mean designing, analysing and interpreting DCEs across multiple fields – to possibly feel comfortable endorsing me when I say “I didn’t use the model dictated by the BIC criterion – or whatever statistical rule you may like – because it routinely gives too many latent classes and I used my experience to choose the best model”. Sorry, yes I sound arrogant, but when any one DCE has literally an infinite number of solutions – a point still ignored or misunderstood by most practitioners – then inevitably experience and gut feelings based on intimate knowledge of your sample, data and survey become paramount.

In short, model selection skills can’t be taught, they must be gained with experience.

And, you are fully entitled to say “well you would say that, you work in industry now”. To which I’d respond, yes, I do have an interest in saying that, but why are academic groups that routinely delay competitor groups’ papers, mis-reference things in order to skew publication metrics and funding likelihood etc not pulled up on their shenanigans? I got a google citation report just today to something – and seeing the authors I would have bet (before reading) 100 GBP with anyone on the planet that the paper of mine that was absolutely crucial to this new publication would not be the citation I got the report for. I would have won the bet, the citation was to something else of mine entirely. I just laugh at these things now, they don’t affect me or my business, but it’s rather sad that they still go on. Particularly in this case when it can contribute to more QALY valuation studies that can’t possibly give the right answer – how is that defensible on equity or efficiency grounds?

So, until basic rules of research – and we’re talking the stuff I was taught in my first PhD supervision like “get the primary source”, not even the more recent transparency stuff – are followed consistently by academics I’m afraid industry is entitled to retort “people in glass houses shouldn’t throw stones”.

research council funding

EDIT 27 July 2016: Just to clarify, this post is not due to any current issues/proposals/projects. It is a piece I have had in mind for a long while now but couldn’t realistically write whilst I was still under funding/contractual obligations. Recent encounters with other funders have (so far, fingers crossed, touch wood) been more positive!

 

Funding by UK health and EU funding councils has, in my experience, been less than satisfactory. Cuts that seem totally arbitrary have been made. In fact I cannot recall a single discrete choice experiment (BWS) study since the original ICECAP-O study that has been fully funded.

Universities I worked at pretty much absorbed the costs. Now, this was partly because all the valuation exercises I have been involved in have raised new issues. But more recent examples have been particularly annoying for my collaborators – they have ended up putting in a lot of extra time. It made me feel guilty, thinking “perhaps I should have costed more time”. But the truth is, whatever I asked for in the past, I got cut BIGTIME.

This comes back to issues that I have had close to my heart for a while now, the issues of (1) what exactly “discrete choice modelling” (DCM) is as a discipline and (2) where it sits within health services research (at least for its application in health). I personally consider choice modelling to be an entire discipline and when in health to be a subdiscpline of HSR akin to “qualitative research” or “biostatistics”. Now, funded trials would not dream of having a jobbing RA to do a fully-fledged qualitative project within a programme grant, nor have an RA do all the biostatistics. So why does DCM get treated as the poor relation? There should ALWAYS be an expert (with 15+ years of experience) in charge of the DCM, with a junior to learn. Because discrete choice experiments (DCEs) are NOT just a branch of health economics or biostatistics. Choice modelling is a discipline in its own right, with a totally different set of statistical skills, economic assumptions and especially psychological knowledge required to do it successfully. It most definitely IS NOT just another preference elicitation method.

Qualitative research quite rightly fought hard to gain acceptance as an equal partner in HSR studies. DCM should too. It’s simply not good enough to have juniors doing DCEs in major clinical trials. Again, would you get an RA without specific training to do all the biostats? No? Then why is it considered acceptable in DCM?

Those of us who spent over 15 years learning our trade find it, frankly, a little insulting, that someone from an MSc or PhD should be considered able to run a DCE in a trial. DCE analysis is not purely a science. It’s very difficult to teach. It’s part art. Do it for 10+ years – ACROSS MULTIPLE DISCIPLINES – then you are just about able to do it properly.

May we have some acknowledgement that what we do is important please?

This isn’t just for the benefit of us “insiders”: the industry loses since the standards of reporting and conduct have not, in my opinion, improved much at all in health. Sooner or later (and sooner if one study I have in mind in a major journal is compared with real preference data) the results of a poor DCE will be comprehensively discredited. Then we all lose. Actually I don’t. Because I do studies predominantly for the private sector who are very sensitive to incorrect results. They commission me because I get them good results. But it’d be a shame if DCM is lost to the public sector. All because nobody wanted to pay for senior people to do things correctly.

I’m told I can be too negative. Fair enough. Yes – standards are a LOT better than 10 years ago. But please remember, whilst the health field has moved on, those fields way ahead of you (marketing/environmental econ/transport econ etc) have also moved on. A lot. You’ve caught up a little. But not by enough. Experience has become doubly important – reading the literature won’t tell you how to do a DCE perfectly. Because of that dirty little secret…..there are an infinite number of solutions to a DCE. If you’ve not analysed 20+ DCEs are you really confident you know what solution to quote to policymakers? Particularly in health where the “tricks” available to solve the problem in other disciplines are not available? I’ll end with a quote:

Harry Callahan: “Uh uh. I know what you’re thinking. “Did he fire six shots or only five?” Well to tell you the truth in all this excitement I kinda lost track myself. But being this is a .44 Magnum, the most powerful handgun in the world and would blow your head clean off, you’ve gotta ask yourself one question: “Do I feel lucky?” Well, do ya, punk?

You are playing with a loaded gun if you don’t know enough about what solutions make sense and what will blow your reputation up. Do you feel lucky?