Treatment Choice With Trial Data: Statistical Decision Theory Should Supplant Hypothesis Testing

Abstract

A central objective of empirical research on treatment response is to inform treatment choice. Unfortunately, researchers commonly use concepts of statistical inference whose foundations are distant from the problem of treatment choice. It has been particularly common to use hypothesis tests to compare treatments. Wald’s development of statistical decision theory provides a coherent frequentist framework for use of sample data on treatment response to make treatment decisions. A body of recent research applies statistical decision theory to characterize uniformly satisfactory treatment choices, in the sense of maximum loss relative to optimal decisions (also known as maximum regret). This article describes the basic ideas and findings, which provide an appealing practical alternative to use of hypothesis tests. For simplicity, the article focuses on medical treatment with evidence from classical randomized clinical trials. The ideas apply generally, encompassing use of observational data and treatment choice in nonmedical contexts.     

Realistic Free-Spins Features Increase Preference for Slot Machines

Despite increasing research into how the structural characteristics of slot machines influence gambling behaviour there have been no experimental investigations into the effect of free-spins bonus features—a structural characteristic that is commonly central to the design of slot machines. This series of three experiments investigated the free-spins feature using slot machine simulations to determine whether participants allocate more wagers to a machine with free spins, and, which components of free-spins features drive this preference. In each experiment, participants were exposed to two computer-simulated slot machines—one with a free-spins feature or similar bonus feature and one without. Participants then completed a testing phase where they could freely switch between the two machines. In Experiment 1, participants did not prefer the machine with a simple free-spins feature. In Experiment 2 the free-spins feature incorporated additional elements such as sounds, animations, and an increased win frequency; participants preferred to gamble on this machine. The Experiment 3 “bonus feature” machine resembled the free spins machine in Experiment 2 except spins were not free; participants showed a clear preference for this machine also. These findings indicate that (1) free-spins features have a major influence over machine choice and (2) the “freeness” of the free-spins bonus features is not an important driver of preference, contrary to self-report and interview research with gamblers.     

The effect of fast and slow decisions on risk taking

We experimentally compare fast and slow decisions in a series of experiments on financial risk taking in three countries involving over 1700 subjects. To manipulate fast and slow decisions, subjects were randomly allocated to responding within 7 seconds (time pressure) or waiting for at least 7 or 20 seconds (time delay) before responding. To control for different effects of time pressure and time delay on measurement noise, we estimate separate parameters for noise and risk preferences within a random utility framework. We find that time pressure increases risk aversion for gains and risk taking for losses compared to time delay, implying that time pressure increases the reflection effect of Prospect Theory. The results for gains are weaker and less robust than the results for losses. We find no significant difference between time pressure and time delay for loss aversion (tested in only one of the experiments). Time delay also leads to less measurement noise than time pressure and unconstrained decisions, and appears to be an effective way of decreasing noise in experiments.     

The Development of Object Construction From Infancy Through Toddlerhood

Early in development, children explore and combine objects in increasingly complex ways. One manual skill, object construction, represents a major shift in how objects are explored relative to other objects. Despite recent connections with cognitive functioning such as spatial skills, the development of object construction ability has rarely been studied and its trajectory has not been adequately described. The purpose of this study was to describe the development of three types of object construction (stacking, nesting, and affixing) across 5 monthly infant visits and 7 monthly toddler visits using a longitudinal design and a large sample size. Infants (10–14 months, n = 131) and toddlers drawn from the infant sample (18–24 months, n = 65) were given sets of age‐appropriate toys each of which elicited at least one type of constructive play. We described success at different construction tasks and identified trends for construction skill for infant and toddler development using multilevel modeling. We found that each of the three construction actions developed in unique ways across the 10‐ to 24‐month period. Infant construction skill predicted the development of toddler skill, but toddler construction skill diverged from infant trajectories. We discuss the role of combination strategies in the development of object construction skill and how object construction could be related to other domains of development.     

A latent variable model for analyzing mixed longitudinal (k,l)-inflated count and ordinal responses

A random effects model for analyzing mixed longitudinal count and ordinal data is presented where the count response is inflated in two points (k and l) and an (k,l)-Inflated Power series distribution is used as its distribution. A full likelihood-based approach is used to obtain maximum likelihood estimates of parameters of the model. For data with non-ignorable missing values models with probit model for missing mechanism are used.The dependence between longitudinal sequences of responses and inflation parameters are investigated using a random effects approach. Also, to investigate the correlation between mixed ordinal and count responses of each individuals at each time, a shared random effect is used. In order to assess the performance of the model, a simulation study is performed for a case that the count response has (k,l)-Inflated Binomial distribution. Performance comparisons of count-ordinal random effect model, Zero-Inflated ordinal random effects model and (k,l)-Inflated ordinal random effects model are also given. The model is applied to a real social data set from the first two waves of the national longitudinal study of adolescent to adult health (Add Health study). In this data set, the joint responses are the number of days in a month that each individual smoked as the count response and the general health condition of each individual as the ordinal response. For the count response there is incidence of excess values of 0 and 30.     

Social Cognitive Factors,Support, and Engagement: Early Adolescents’ Math Interests as Precursors to Choice of Career

The authors examined the central hypothesis that students’ early perceptions of support and sense of engagement in math classes and math activities strongly influence the broadening or narrowing of their math interest. The focus was on the first wave of qualitative data collected from 5th‐, 7th‐, and 9th‐grade students during the 2007–2008 academic year as part of a longitudinal study. Findings indicate the importance of using group work and extrinsic motivation in middle school math classes to broaden interest; peer classroom behavior was often a detractor of math interest.     

The German East-West Mortality Difference: Two Crossovers Driven by Smoking

Before the fall of the Berlin Wall, mortality was considerably higher in the former East Germany than in West Germany. The gap narrowed rapidly after German reunification. The convergence was particularly strong for women, to the point that Eastern women aged 50–69 now have lower mortality despite lower incomes and worse overall living conditions. Prior research has shown that lower smoking rates among East German female cohorts born in the 1940s and 1950s were a major contributor to this crossover. However, after 1990, smoking behavior changed dramatically, with higher smoking intensity observed among women in the eastern part of Germany. We forecast the impact of this changing smoking behavior on East-West mortality differences and find that the higher smoking rates among younger East German cohorts will reverse their contemporary mortality advantage. Mortality forecasting methods that do not account for smoking would, perhaps misleadingly, forecast a growing mortality advantage for East German women. Experience from other countries shows that smoking can be effectively reduced by strict anti-smoking policies. Instead, East Germany is becoming an example warning of the consequences of weakening anti-smoking policies and changing behavioral norms.