Stephanie Harvard (Simon Fraser University)
The values in science literature has resulted in much debate, as well as many examples of value judgments that scientists make in the course of their work. Several examples have emerged in climate change and other types of simulation modelling, but examples are lacking from health economics, which also relies heavily on modelling. A better understanding of value judgments in the modelling process would assist health economists involved in 'patient-oriented' research initiatives, which have the goals of 1) engaging patients throughout the research process, and 2) providing patients with meaningful opportunities to influence research decision-making (Canadian Institutes of Health Research 2011). This work aims to develop a taxonomy of value judgments in health economics modelling, building on Biddle and Kukla's (2017) concept and 'geography' of epistemic risk. First, I examine Biddle and Kukla's concept of 'alethic' risk, and argue that there are additional risks that can plague beliefs "once we have them" (p.218), beyond the singular risk that the beliefs will be mistaken (here, I take the term 'belief' to be interchangeable with 'knowledge', as what is sought in research). These include the risk that the knowledge will be true but misleading (e.g., as occurs when a well-researched intervention is deemed cost-effective, but an overlooked intervention is far more cost-effective); the risk that the knowledge will be true but futile (e.g., as occurs when an intervention is deemed not cost-effective but does not affect decision-makers' commitment to funding it and patients' commitment to seeking it); and the risk that the knowledge will be unwelcome (e.g., as occurs when the knowledge reinforces problematic concepts, including when health economics studies represent benefits of an intervention that matter to health providers and/or decision-makers and omit benefits that matter to patients). I then expand and re-work the list of 'phronetic' risks outlined by Biddle and Kukla (2017) using examples from health economics. As a means to evaluate my revision to Biddle and Kukla's (2017) list of epistemic risks, I then review four major challenges to the Value-Free Ideal (VFI) and examine whether they bring to light any additional types of epistemic risk not yet captured. I argue that the re-worked list allows for all four challenges to the VFI to be grouped according to the epistemic risks that they highlight, and, furthermore, that grouping the challenges to the VFI in this way captures their importance yet directs attention away from the task of undermining the VFI and toward the task of a developing a taxonomy of value judgments in health economics modelling. Finally, I present a case that all epistemic risk carries with it an ethical risk, thus arguing in favour of representing the two types of risks as fully overlapping. I conclude by considering implications for patient-oriented health economics research.
