User talk:Hauskalainen

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Contents 1 Uncertainty in Economic Evaluation of Health Care Technologies 2 sorry 3 "Right-wing" 4 Waiting times in Canada 5 RfC

[edit] Uncertainty in Economic Evaluation of Health Care Technologies

RCTs provide an approximation of true population values. They are not perfect estimates (although as their size and quality of execution increases they do get closer to true values). By looking at how important uncertainty over our parameter estimates is (i.e. do small shifts change our conclusions? and does this matter?) we can decide whether it is worthwhile to strenghten the evidence we have before making a decision on approval.

We should doubt always doubt methodology used in such serious context. Whilst RCTs are the best we have if we are basing conclusions on low power evidence with great uncertainty (i.e. the results they present suggest a range of possible efficacy values) it may be worthwhile requiring more RCTs be done before accepting a technology. In this context I am not doubting NICEs methodology as they do consider this factor.

I suggest you read the chapters of uncertainty in economic evaluation in the Briggs, Claxton, Sculpher book I referenced for more information. Uncertainty is a key consideration of NICE appraisals and required to be assessed by PSA in the NICE reference case. If the statement you deleted were not true uncertainty of efficacy would not be an issue (as all RCTs would provide perfect values) and would not be required to be assessed by NICE. In reality it is as RCTs provide estimates not true population values and can be strenghtened through further evidence.

Hopefully this has convinced you of the logic behind my statement. If it has not then read Claxton, Briggs and Sculpher. All 3 work closely with NICE and you should definitely read their book if you wish to truly understand NICE methodology.

Are you referring to this text in the NICE article in which I deleted the test which I have here put in bold?

As NICEs decisions are made upon the basis of the synthesis of estimates of population parameters derived via clinical trials (see decision analytic modeling) they are subject to a certain degree of uncertainty (as a clinical trial only represents the paramaters produced by a population sample, not necessarily the population itself). If this uncertainty is high, the consequence of a wrong decision sizeable (perhaps due to large required capital investment) and the cost of acquiring further information acceptable NICE can approve a technology for research only

The reason I deleted the text was that it, to me, stated the obvious, but in the mind of an uninformed reader it could sow doubt about NICE's decision making competance. Of course the population sample size and make up is important and of course NICE is fully aware of this and takes this into account as it makes decisions and recommendations. There is a lot of ongoing debate in the United States right now about what they term "comparative effectiveness research", but is effect what NICE does. The health Insurance industry in America is backing CER presumably because it would enable them to stop funding ineffective treatments, but certain politicians in the U.S. are trying to block the public sector funders from using CER to limit coverage. Which of course would in the long term mean that private insurers would be more effective than any public insurer. The same politicans denouce CER as rationing and claim it goes against "personalised medicine". I just thought that it seemed churlish to give them more ammunition.--Hauskalainen (talk) 09:27, 26 June 2009 (UTC)

[edit] sorry

my sincere apologies for the misunderstanding regarding the chart in 'gun violence'. if it had been clear from the outset that fully half the data in the chart was derivative, and that you were correcting those derivative values, there'd have been no issue. it was my fault for not examining the source data more carefully. Anastrophe (talk) 02:05, 8 April 2009 (UTC)

Apology accepted. --Hauskalainen (talk) 09:22, 8 April 2009 (UTC)

[edit] "Right-wing"

Just for your information, the terms "left-wing" and "right-wing" carry connotations of extremism in the US that they don't necessarily convey in the UK and Europe. As a result, using such terms in US-centric article to describe a mainstream politician is going to be seen as an accusation rather than as a simple fact. -Rrius (talk) 05:20, 12 May 2009 (UTC)

[edit] Waiting times in Canada

You have added some statistics to the section Socialized_medicine#Waiting_times. Can you include your reference for these statistics? Thanks.—C45207 | Talk 21:45, 31 May 2009 (UTC)

The reference was there but maybe not clearly visible. I have corrected this. I know that there is a better way tp do repetitive referencing within an article but I can never remember how to do it and I can't find it in the WP editing help pages.--Hauskalainen (talk) 10:36, 2 June 2009 (UTC)

--Hauskalainen (talk) 09:24, 15 June 2009 (UTC)

[edit] RfC

Why did you close the discussion at Talk:Gun violence and re-add the list precisely as it was, without addressing my first and second points? I will watch this page for your response. Thanks, Abrazame (talk) 00:43, 15 June 2009 (UTC)

Hi Abramzame. The discussion agreed that it was wrong to delete useful information from the table. It had been open for some time and only one person (one of two people who deleted the useful information from the article) objected, though even he agreed later that the information can go back in. The issue of deleting the information was the issue at point. I have noted the issue you raiswd about discrepant data. I had a quick look at the table before adding it back and I could only see India as having a column that did not match. I have not had time to correct this yet but will do so later. As to the point about fomatting, I am not skilled enough in building tables to know how this is done and frankly I do not have the time. But if you know that this can be done and know how to do it, by all means please help us out. The extra column wil be deleted in time. either I will do it or someone else. Its on my list but a bit way down at the momenmt. Thanks for your contribution.--Hauskalainen (talk) 09:24, 15 June 2009 (UTC)