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Legal status of reporting post-hoc subgroup results

  • 1.  Legal status of reporting post-hoc subgroup results

    Posted 03-03-2020 17:20

    Some time ago, we discussed the question whether reporting results of a post-hoc subgroup analysis without clearly indicating the nature of the analysis performed and the exploratory nature of the results is illegal and whether it is or should be made a crime.

    At the time, my view was that, understanding that the practice can be highly misleading and lead people to action based on error and noise, the practice is unfortunately so entrenched that as a pragmatic matter it would probably need to be criminalized explicitly. We are positively inundated with chance phenomena presented as meaningful, and with subgroups presented as significant when they are a actually selected from large frames of them in a manner which goes unreported.  To pick one example of many, just look at how financial funds are rated. We see lots of funds with good-looking 5-year performance ratings. But the only funds that receive 5-year performance rates are those that have survived 5 years. And the only funds that survive 5 years are those that have performed reasonably well, quite possibly by chance.  We never see the funds that are closed. 

    While I don't know the outcome of the upcoming elections, it is possible that we will have a Congress interested in revisiting and clarifying the trade practice laws.

    If so, this might be the sort of thing that the ASA should take a policy position on. 

    I understand that the ASA does not like to take positions on statistical practice. But there are certain practices that are so egregious that explicit clarification of the law might be in everyone's interest. 



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    Jonathan Siegel
    Director Clinical Statistics
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  • 2.  RE: Legal status of reporting post-hoc subgroup results

    Posted 03-04-2020 07:06
    Making something illegal would imply that the NIH mandate of making data public could put all who use the data at risk of post hoc crimes.  Maybe we need more clarity in papers, but subgroup analyses often confer confidence in results by showing consistency and with mandates to reliability and reproducibility, and more not fewer subgroup analyses will be done.  Statistical literacy is an important goal and we should teach it at all levels of schooling as a deterrent from the misunderstanding of the crimes you cite.  Your example is a very good one, but not for the crime of subgroup analyses, rather informative censoring and/or biased analyses.  In clinical research we would have to get rid of informed consent and willing participation to avoid your form of subgroup analyses crimes.

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    [Gary] [Cutter]
    [Emeritus Professor]
    [UAB School of Public Healtth]
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  • 3.  RE: Legal status of reporting post-hoc subgroup results

    Posted 03-04-2020 11:38
    Gary, Can you clarify what you meant by this:
    "In clinical research we would have to get rid of informed consent and willing participation to avoid your form of subgroup analyses crimes."

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    David Stokar
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  • 4.  RE: Legal status of reporting post-hoc subgroup results

    Posted 03-05-2020 02:26

    To clarify, the illegal act would be, not performing post-box subgroup analyses, but starting with a large number of groups, selecting the small number that come out as statistically significant, and then making claims based on representing those as the only ones that were looked at. 

    The FTC currently has a legal case based on a theory that the practice represents an unfair and deceptive trade practice. In FTC v. Quincy Bioscience Holding Company, the FTC is claiming that after a failed study, Quincy Bioscience conducted post-god analyses of over 30 subgroups, found no statistical significant beneficial effect in the vast majority of these subgroups, but the results showed "a few isolated subgroups and tasks" in which the study showed statistically significant improvement. According to the complaint, the company then conducted a marketing campaign representing these findings as the results of the study, I.e. the study showed that the product improved memory in the specific subgroups and tasks for which the post-box analysis had shown statistically significant results.

    Originally, criminal charges were brought. But the judge dismissed the charges on grounds that, basically, post-hoc subgroup analysis is so commonly done as not to make clear beyond a reasonable doubt that it is criminally misleading. The FTC then brought a civil suit,  which is pending. 


    What do we make of all this? The case should make clear that it is not simply the act of doing post-hoc subgroup analyses that's at issue. The problem is representing those analyses as the study's results, as if they had been the study's purpose all along. These conditions should clearly insulate liability anyone who acknowledges both the post-hoc nature of the analyses and the existence of a larger set of things they looked at from which the significant results were cherry-picked. 


    The case also makes clear that there is no clear law on the subject, and the courts are in debate about what to do about it. 


    Perhaps the ASA should have a position.

    The 2nd Circuit decided an appeal on narrow grounds and sent the issue back to the trial court. 

    As this is a legal matter, I'd better reiterate that the views here are mine alone and not those of my employer.

    The FTC's argument, which explains why it thinks this type of representation represents an unfair and deceptive trade practice, is here:

    https://www.ftc.gov/system/files/documents/cases/quincy_bioscience_ca2_ftc_brief_special_appendix_2018-0228.pdf

    Ftc remove preview
    View this on Ftc >








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    Jonathan Siegel
    Director Clinical Statistics
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  • 5.  RE: Legal status of reporting post-hoc subgroup results

    Posted 03-06-2020 09:00
    I sincerely apologize, but my browser's automatic spelling check in its wisdom appears to have repeatedly corrected the word "hoc," coming up with some very creative substitutes, without my realizing it. Unfortunately, there's no way to edit a post once submitted. I will attempt to introduce it to the word, or else my life will get more interesting.

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    Jonathan Siegel
    Director Clinical Statistics
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  • 6.  RE: Legal status of reporting post-hoc subgroup results

    Posted 03-06-2020 09:54
    The NIH, in cooperation with journal editors, implemented "ClinicalTrials.gov" (I don't know how many years ago now) as a regulatory response to this exact problem. It requires the principal investigator to register the study hypotheses, design, protocol, allocation method and specify primary and secondary outcomes and endpoints, and describe the planned statistical analysis before subject recruitment begins.
    Journal editors agreed, at the time, to not accept manuscripts that failed to properly register the study in "ClinicalTrials.gov".
    So a procedural-regulatory approach was chosen over a legal-criminal alternative.
    Please see https://clinicaltrials.gov/ct2/about-site/background for specifics.

    ... don

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    [Donald J] [McMahon]
    [Statistical Consulting Services]
    [Nyack] [NY]
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  • 7.  RE: Legal status of reporting post-hoc subgroup results

    Posted 03-06-2020 12:26

    Quincy Bioscience Holding Company's product was a dietary supplement rather than a drug, which was why the FTC rather than the FDA.

    Clintrials.gov is only relevant to matters subject to the FDA. So far from exactly fitting the example, it's not relevant to it at all. And it's not relevant to anything else not involving an FDA regulated drug, biologic, etc. 

    Moreover, if Clintrials.gov had been relevant, nothing would have prevented Quincy from simply registering with Clintrials.gov and then issuing the exact same advertisement the FTC had labeled misleading. Few recipients of advertisements for dietary supplements likely even know Clintrials.gov exists, let alone would think to check advertisements against it. It seems unlikely the existence of an obscure database would make much difference.

    And even if the public would notice, the penalty for failing to register is an administrative fine, a "civil monetary penalty." of up to $250,000 per violation. There is no criminal penalty of any kind. It might be perfectly rational from a profit perspective for a business to consider such a penalty nothing more than a tax, part of the cost of doing business, and well worth it if the profits are expected to sharply exceed it. 


    The FDA has stronger penalties for misleading advertising and stronger control over and say in what it considers misleading than exists in the general case. But the case of concern is the general case of advertising or making representations to the public that something was scientifically proven based on a cherry-picked post-hoc analysis, not special areas with existing special laws.  



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    Jonathan Siegel
    Director Clinical Statistics
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  • 8.  RE: Legal status of reporting post-hoc subgroup results

    Posted 03-05-2020 11:42
    ​Legality is for lawyers, not us.  Gary is correct that legal restrictions will stifle research.  No protocol can write every conceivable analysis into it. Ideas come forward post-hoc, and they need to be done honestly with appropriate caveats.  The article reviewers have to be given full disclosure and act accordingly.   But post hoc analyses are wonderful generators of new research whether the motivator was legit or not. 

    Jon

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    Jon Shuster
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  • 9.  RE: Legal status of reporting post-hoc subgroup results

    Posted 03-04-2020 11:35

    Jonathan, you raise a very interesting (and not so) side point and I like your example from the financial industry.  But perhaps criminalizing it is going too far (and how would one police that).  Perhaps the ASA would be better off publicizing examples such as those.  I don't see any current Statistical organizations (such as the ASA) publicizing clear offending examples such as this one.  That may be a better use of the ASA resources and skills.



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    David Stokar
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  • 10.  RE: Legal status of reporting post-hoc subgroup results

    Posted 03-05-2020 16:58

    I do not think a free society will ever want to criminalize what legislators or putative experts regard as bad science, though marketing products or securing funding for research while knowingly relying on or employing bad science may often be fraud. 

    Anything regarding subgroup effects, at least when involving binary outcomes, is an especially problematic area for criminalizing bad science.  Consider an intervention that improves cancer survival.  Typically, it will cause a larger proportionate decrease in mortality among a group with a lower baseline mortality rate (e.g., young subjects) while causing a larger proportionate increase in survival among a group with a higher baseline mortality rate (e.g., older subjects).  In fact, it would be remarkable for this not to happen whenever an intervention has a substantial effect and the groups being compared have substantially different baseline mortality/survival rates.  Yet, so far as the published record reveals, few if any persons analyzing subgroup effects are aware that it is even possible for one group to experience a larger proportionate benefit from an intervention with respect to a decrease in mortality while the other group experiences a larger proportionate benefit from the intervention with respect to an increase in survival.

    Further, subgroup analyses involving binary outcomes usually are premised on the belief that, absent a subgroup effect, a factor that affects an outcome rate will show the same proportionate effect on different baseline rates for the outcome (or, more precisely, the side of the favorable/adverse outcome dichotomy one happens to be looking at).  Yet, it should be evident such an expectation is illogical, given that it is impossible for a factor to cause equal proportionate changes in two groups' different baseline rates for an outcome while at the same  time causing equal proportionate change in the groups' rates of experiencing the opposite outcome.  Similarly, anytime a factor causes equal proportionate changes in two groups' different baseline rates for an outcome it will necessarily cause unequal proportionate change in the two groups' baseline for the opposite outcome.

    Regarding a related matter, the employment of an effect observed in a clinical trial to calculate the number need to treat in circumstances where baseline rates differ from that in the trial commonly involves applying the observed relative change in the outcome rate being examined to the baseline rate for the same outcome (i.e., favorable or adverse) for the patient's group.  I assume the same holds for number need to harm.  But virtually unknown to physicians is that one will always derive different, and often dramatically different, numbers needed to treat (harm) depending on whether one employs the observed relative effect on the favorable outcome or the observed relative effect on the adverse outcome.  In such circumstances, a patient who experienced adverse consequences of an intervention undertaken because of a recommendation that was more optimistic than a reasonable approach to calculation of number need to treat (harm) would have supported ought to have a cause of action for negligence.  The physician, of course, would have certain defenses including reliance on sources of presumptive expertise.  Possibly those sources should also be liable civilly. 

    But criminalization is another matter.  Further, legislation about perceived bad science may inadvertently validate science that is at least as bad.         

    As suggested in my November 2016 Comments for the Commission on Evidence-Based Policymaking, my October 2015 letter to the American Statistical Association, and my "Race and Mortality Revisited," Society (July/Aug. 2014),  I consider it manifestly inappropriate, probably seriously negligent, for observers to discuss effects of policies on some measure of demographic difference without consideration of the way the measure tends to be affected by the prevalence of an outcome (especially in circumstances where there is no mention that different measures yield opposite conclusions).  The same holds for any discussion of reasons for a perceived subgroup effect without consideration of the same issues.  But, apart from possible fraud in certain circumstances where the discussants do or should know better, and when the discussants are promoting products or seeking funding, criminalization seems inappropriate.

    Further, as discussed in each of these items, Congress is a manifestly innumerate entity, as reflected by, among other things, its mistaken belief that reducing adverse outcomes tends to reduce, rather than increase, relative racial and other demographic differences in rates of experiencing the outcomes.  See "Innumeracy at the Department of Education and the Congressional Committees Overseeing It," Federalist Society Blog (Aug. 24, 2017).  One should be cautious in urging it to consider subjects that it may not be able to understand.



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    James Scanlan
    James P. Scanlan Attorney At Law
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  • 11.  RE: Legal status of reporting post-hoc subgroup results

    Posted 03-06-2020 09:17
    I had to go back and read the original email to be sure what was really being said. There are two conditions that need to be met.

    1. A subgroup analysis is done, AND
    2. the researchers fail to label the results as exploratory.

    The dividing line for when something has to have a label of "exploratory" attached is rather vague. Suppose that the subgroup analysis meets most of the Sir Austin Bradford Hill criteria? It has a plausible mechanism, the effect size is very large, it shows a dose response relationship, it is supported by previous research findings, etc. I don't know about Dr. Siegel, but I would find that result to be very convincing.

    Once we start policing this, are we going to insist on "exploratory" disclaimers when you use a historical control group? If you rely on a quasi-experimental design? If your dropout rate is greater than 10%?

    I do have some sympathy with Dr. Siegel's arguments. Withholding information that the public needs to assess the validity of medical claims can sometimes rise to the level of fraud. But the way to combat this is to demand that researchers publish their protocols in a registry prior to data collection. Failure to do so should be accounted for in the peer-review process. Perhaps this could also be added to the various checklists published by the EQUATOR group.

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    Stephen Simon, blog.pmean.com
    Independent Statistical Consultant
    P. Mean Consulting
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