Academic economics was in the same place in the mid 80s. Fancy econometric models were used to “fix” non-random assignment in international studies. In 1986 the American Economic Review published a paper by Robert Lalonde where he took known RCT results and pretended they were observational and applied the econometric “fixes”, with disastrous results. This paper was massively influential and spawned a generation of economists who refused to just throw more math at observational studies but instead focused on finding natural experiments. Folks like Anrgist, Card, Krueger, Levitt. That’s now the standard approach taught to undergrads.
Hopefully RCT-DUPLICATE has the same effect - but unlike in economics, medicine has pharma and the press clamoring for spurious results so we shall see.
Any level III evidence that allows causal language is scary, but I didn't get to vote. When I found out you could use "increased/reduced" the risk to describe the results of a TTE, I thought Oh Boy, here we go. These studies are Level III evidence even if prospective. Because they are NOT randomized. This makes me crazy. At least in the oseltamivir study they used "associated with an adjusted risk reduction of 1.8%." But your average resident is going to cite that study & say Soanddo et al demonstrated that oseltamivir reduced the risk of in-hospital mortality by 1.8%," claiming more than the authors did.
I.will agree.with this proposal, but only if everyone also agrees to rename "pragmatic trials" to become "experiments where the treatment intervention is too weak to ever have the slightest chance of influencing outcomes.". Obviously the new name is still a work in progress.
Academic economics was in the same place in the mid 80s. Fancy econometric models were used to “fix” non-random assignment in international studies. In 1986 the American Economic Review published a paper by Robert Lalonde where he took known RCT results and pretended they were observational and applied the econometric “fixes”, with disastrous results. This paper was massively influential and spawned a generation of economists who refused to just throw more math at observational studies but instead focused on finding natural experiments. Folks like Anrgist, Card, Krueger, Levitt. That’s now the standard approach taught to undergrads.
Hopefully RCT-DUPLICATE has the same effect - but unlike in economics, medicine has pharma and the press clamoring for spurious results so we shall see.
I always appreciate your insights and thoughts. Thank you.
Glad you are back doing this! Whatever you did at the corrupt government agency was invisible to me. This I can use.
Middle authors who didn't help! I died. Hey, they provided resources!
Any level III evidence that allows causal language is scary, but I didn't get to vote. When I found out you could use "increased/reduced" the risk to describe the results of a TTE, I thought Oh Boy, here we go. These studies are Level III evidence even if prospective. Because they are NOT randomized. This makes me crazy. At least in the oseltamivir study they used "associated with an adjusted risk reduction of 1.8%." But your average resident is going to cite that study & say Soanddo et al demonstrated that oseltamivir reduced the risk of in-hospital mortality by 1.8%," claiming more than the authors did.
Thanks
I.will agree.with this proposal, but only if everyone also agrees to rename "pragmatic trials" to become "experiments where the treatment intervention is too weak to ever have the slightest chance of influencing outcomes.". Obviously the new name is still a work in progress.
Building AI models for studies affords biases in the study itself. We’ve already lived through biased modeling schemes.
https://x.com/i/grok/share/980fe995cc304d24845df78a905302c4