Observational Research, Randomised Trials, and Two Views of Medical Science 英文参考文献.docVIP

Essay Observational Research, Randomised Trials, and Two Views of Medical Science Jan P. Vandenbroucke Summary soon as there is a hint of con?rmation, a paper is submitted. The next wave of researchers immediately tries to check this idea, using their own existing data or their trusted lab experiments. They will look at different subgroups of diseased persons, vary the de?nition of exposures, take potential bias and confounding into account, or vary the lab conditions, in attempts to explain why the new idea holds—or why it is patently wrong. In turn, they swiftly submit their results for publication. These early exchanges may lead to strong con?rmation or strong negation. If not, new studies are needed to bring a controversy to resolution. research loops that are a burden to the public purse. In contrast, the discovery type Two views exist of medical science: one emphasises discovery and explanation, the other emphasises evaluation of interventions. This essay analyses in what respects these views differ, and how they lead to opposite research hierarchies, with randomisation on top for evaluation and at bottom for discovery and explanation. The two views also differ strongly in their thinking about the role of prior speci?cation of a research hypothesis. Hence, the essay explores the controversies surrounding subgroup analyses and multiplicity of analyses in observational research. This exploration leads to a rethinking of the universally accepted hierarchy of strength of study designs, which has the randomised trial on top: this hierarchy may be confounded by the prior odds of the research hypothesis. Finally, the strong opinions that are sometimes displayed in pitting the two types of medical science against each other may be explained by a difference in “loss function”: the difference in penalty for being wrong. A longer, more detailed version of this paper is found in supplementary Text S1. of researcher is convinced that too much emphasis on evaluation actua