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statsepi's profile
Darren Dahly, PhD
Darren Dahly, PhD
Darren Dahly, PhD
@statsepi

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Darren Dahly, PhD

@statsepi

Epidemiologist + Statistician | @HRBIreland @CRF_Cork @UCCPublicHealth @UCC | #ClinicalTrials #EpiTwitter #StatsTwitter Views mine https://statsepi.substack.com 

The Abyss of Uncertainty
statsepi.substack.com
Joined October 2010

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    Darren Dahly, PhD‏ @statsepi 4 Aug 2020

    A major short-coming in a lot of epidemiological training is how it breezes over (or completely ignores) randomized, controlled trials....[cont'd]

    11:12 PM - 4 Aug 2020
    • 20 Retweets
    • 105 Likes
    • MSNBC Rocks SkepticalPharmacist Brett Chrest Fabian Juzek (ID advoCATe) David Gorski, MD, PhD Neil O'Leary Tristan Timbrook Noah Haber Madison Anderson, MPH
    12 replies 20 retweets 105 likes
      1. New conversation
      2. Darren Dahly, PhD‏ @statsepi 4 Aug 2020

        There are different reasons for this. E.g. RCTs are the purview medical statistics more focused on treatment, and not as relevant for epi, which is more closely related to public health and prevention.

        2 replies 3 retweets 14 likes
        Show this thread
      3. Darren Dahly, PhD‏ @statsepi 4 Aug 2020

        There is also a perspective that somehow observational approaches to learning from data are somehow more intellectually challenging, and RCTs are simple and easy. Thus if you can design/analyze a cohort study, you are already qualified to design a RCT and analyze the data.

        1 reply 3 retweets 21 likes
        Show this thread
      4. Darren Dahly, PhD‏ @statsepi 4 Aug 2020

        So I just want to suggest, from the perspective of a trained epidemiologist who was thrown into the deep end of clinical trials and is only now starting to feel comfortable doggie paddling, it would be a very good idea to make RCTs a foundational component of epi training.

        2 replies 7 retweets 44 likes
        Show this thread
      5. Darren Dahly, PhD‏ @statsepi 4 Aug 2020

        First, it's embarrassing when one of my fellow epidemiologists assumes they understand RCTs when they have never actually given them more than 2 seconds of thought.

        1 reply 5 retweets 21 likes
        Show this thread
      6. Darren Dahly, PhD‏ @statsepi 4 Aug 2020

        Second, you might actually want to use an RCT eventually! The entire premise of epi seems to be "let's find the modifiable causes and then intervene" but once you get to the "intervene" part...you will probably want to run a trial if you can.

        2 replies 5 retweets 32 likes
        Show this thread
      7. Darren Dahly, PhD‏ @statsepi 4 Aug 2020

        And finally, I can't overstate how much having to think more about RCTs has helped me refine my views on epidemiological questions/designs/analyses. Different contexts, but sharing the same fundamentals for causal and statistical inference, leads to informative contrasts.

        5 replies 3 retweets 39 likes
        Show this thread
      8. End of conversation
      1. Michael Edwards.‏ @MichaelPaulEdw1 4 Aug 2020
        Replying to @statsepi

        You should get better Epi training then?

        0 replies 0 retweets 1 like
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      1. New conversation
      2. Peter Tennant‏ @PWGTennant 5 Aug 2020
        Replying to @statsepi

        The practice of conducting an RCT is indeed on the disputed border or Epidemiology, but the theory is not and most good courses should teach this. You can't understand many of the challenges and pitfalls with observational data without reference to an RCT.

        2 replies 0 retweets 11 likes
      3. Peter Tennant‏ @PWGTennant 5 Aug 2020
        Replying to @PWGTennant @statsepi

        I think a lot more can and should be done bringing a formal causal inference perspective to the conduct and analysis of RCTs. @EpiEllie's work in particular shows the importance of that. But the RCT 'community' is quite hostile to people on the 'outside' dabbling...

        2 replies 0 retweets 3 likes
      4. Show replies
      1. New conversation
      2. Andreea Steriu‏ @SteriuMD 5 Aug 2020
        Replying to @statsepi

        There is this myth that any clinician can run an RCT. One still needs a team to do so. Epi has a planning role. Too many non-epi dab into epi work. At end of study clinicians start looking for 'who is available' to look at the data. My 1st Q now is 'has ICH-GCP been followed?'

        1 reply 1 retweet 4 likes
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