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Correlation Is Not Causation, Wink, Is Not Good Enough for Observational Research
Cardiology researchers Bob Harrington and Bobby Yeh discuss how to do better observational research and the controversial notion of making causal inferences from such data.
www.medscape.com/viewarticle/1000264?src=soc_yt
-- TRANSCRIPT --
Robert A. Harrington, MD: Hi. This is Bob Harrington from Weill Cornell Medicine on Medscape Cardiology | theheart.org. Over the years, we've talked often on this show about randomized clinical trials. We talk about some of the latest research coming out of observational analyses, outcomes-based research, and we've had discussions about which one is a better form of evidence or a stronger form of evidence. Is it the randomized clinical trial? Is it a well-done observational analysis? The answer is that it depends.
It depends on what your question is. It depends on the datasets that you're using. It depends how the trial was done. What we're really trying to do is to understand whether or not we have reliable information coming out of a research study that allows us to make decisions about how we might be treating our patients. This also involves things like causal inference, and we're going to talk about that today.
I can't think of a better person to have this conversation with today than my good friend and colleague, Dr Bobby Yeh from Harvard. Bobby is the Katz-Silver Family Professor of Medicine at Harvard Medical School, and he's also the director of the Richard and Susan Smith Center for Outcomes Research at the Beth Israel Lahey Medical Center in Boston. Bobby, thanks for joining us here on Medscape Cardiology.
Robert W. Yeh, MD, MSC: Thanks for having me, Bob.
Harrington: It's been a few years. You reminded me before we got on the air. If I think about it, last time you and I talked, you were having a baby. What did you say? You now have a 5-year-old, so it's been a while.
Yeh: I do. He's almost 6, so it's been a little bit.
Harrington: It's been a while. I think last time we talked, we talked about Twitter. You had written a paper about democratization of knowledge through social media.
Yeh: That's right. That's gone a little sideways since that paper.
Credible Observational Research
Harrington: Twitter has definitely gone sideways. The reason I wanted to invite you to talk about this topic is twofold, one of which is it's something that you and I have talked about often at medical meetings, at conferences - this whole notion of the strength of evidence, how we assess evidence, and what kind of level of evidence do we need.
You wrote a really important paper last summer, which is the second reason I invited you. It's called, "Bringing the Credibility Revolution to Observational Research and Cardiology." I know you've talked with others about the topic, and I thought, You know what, it's still a pretty important topic. It was really important during COVID, wasn't it, as people were trying to put forward all sorts of observational analyzes to try to help us gain insight rapidly into what therapies might be of value?
Thanks for joining me. Let's maybe start with the biggest picture, Bobby. Why did you write the paper?
Yeh: It's a topic that I've been thinking about for many years, obviously, and we've had many discussions over the years, and our colleagues here have as well. It's an area that we do a large amount of research in here, which is, how do we get more credible estimates out of our observational analyses for comparative effectiveness research? We have had a particular interest in the past few years working with the FDA, and more recently CMS, to understand the value of real-world evidence, and I think it's a very polarizing topic.
It's a topic that you can find people who swear that they'll never trust an observational study, and you find others who say that they really can believe the causal interpretability of a well-done observational study. Very smart, reasonable people can disagree strongly on this issue. I felt like there has been a real challenge that we faced in cardiology, and really, across medicine - but our field is cardiology. I felt that it was time to talk about at least some of the challenges in how we might move that discussion forward.
Transcript in its entirety can be found by clicking here:
www.medscape.com/viewarticle/1000264?src=soc_yt
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КОМЕНТАРІ

  • @BatMan-pm1jq
    @BatMan-pm1jq 28 хвилин тому

    ❤❤

  • @ahlamamr4659
    @ahlamamr4659 17 годин тому

    I have been diagnosed with Abscence epilepsy after I got a status epilepticus seizure (I just learned that name). It’s was like loosing consciousness every couple of seconds and falling. I used to get like a lot of jerking mouvements in my senior year because of stress. And I got a tonic clonic seizure a couple of months ago it was the worst. But anyways I sometimes feel like I nerves are tickilish or relaxed or weak that it’s very hard to move. Like I can move but I need a lot of will power. Does anyone know if it maybe related? Or experience something similar?

  • @kyleentenman4450
    @kyleentenman4450 23 години тому

    Who is the guy who looks like he’s have falling asleep? Had he have any idea of what true depression is like? You’re living in the past Charlie - are you afraid of addiction, because more and more people are taking themselves out while you blab on about how frightening the “data” is. Get a life and help some people- your negativity is one of the reasons that psychiatry remains largely viewed as fake and quackery.

  • @felicia7756
    @felicia7756 День тому

    I believe this data is for education, physician study. I'm sure the students and specialists doctors are able to keep up🙂

  • @aneva2464
    @aneva2464 День тому

    Cephalexin considered safe ?

  • @christyagnew135
    @christyagnew135 День тому

    My daughter was diagnosed at age 3, now 18. I desperately want to understand how these chemicals have affected her brain development, social and emotional development, and mental health. She doesn't remember the majority of her childhood, and now struggles with mental health. Began as she quit the blockers to let nature take it's course. Any directions to look are appreciated.

  • @kentheengineer592
    @kentheengineer592 2 дні тому

    3:30 that's where ur making an oversight

  • @user-su6hc9cd7e
    @user-su6hc9cd7e 2 дні тому

    Good information here thank you. I've got it right now and was wondering how long it lasts.

  • @freyaafarooq9663
    @freyaafarooq9663 2 дні тому

    In zedex procedure does nail grow back?

  • @dougpage1132
    @dougpage1132 3 дні тому

    Many modern cardiologists are not using statins, because they almost do nothing.

  • @its_abbzgaming5612
    @its_abbzgaming5612 4 дні тому

    Its inhumane to allow any human to suffer they won't allow an animal to suffer coz it's inhumane but its more inhumane to allow any human to suffer so profoundly that your only thought to end or stop or reduce the pain is to kill yourself and then you look around at your loved ones feeling guilty and not receiving any help what's so ever from the medical professions and not knowing what elts to try or who elts to ask for help that can help n not just saying go do counselling n talk about how much your suffering but not doing anything about the actual problem the pain n living so inhumaninly because of the amount of pain but thank you to all who do these videos maybe one day they will listen but unfortunately after 22 years of suffering in agony I guess I wasn't strong enough to see any changes or anyone helping or even listening to all of use suffering in so much chronic pain I would rather be egielised or tortured shot or anything elts you could think off than live another day so inhumaninly

  • @sfiasphere6606
    @sfiasphere6606 4 дні тому

    I'm going to guess, its flesh eating bacteria ,and using methylene blue as the antiseptic and recovery

  • @janejenkins5137
    @janejenkins5137 5 днів тому

    I completed an ultra marathon just a few months before getting long covid. I wasn't depressed, I was planning my next marathon and training to be an ML before this! I've never experienced anything like this before and it's ruining my life. It's like waking up in someone elses body!

  • @johnmitchell8925
    @johnmitchell8925 6 днів тому

    I believe the data I got was most of the people that died from an opioid overdose, the opioid was not prescribed to them

  • @717JHT
    @717JHT 6 днів тому

    I do have muscle related symptoms when I have gluten crosscontamination, you said in your video that there is no symptoms, but I do have them, within minutes of ingestion, I don’t know how to describe it, but it seems that my entire skin and muscles start feeling heavy as lead, it’s very difficult, no energy whatsoever, feels like dying; you sleep well at least.

  • @kiwipics
    @kiwipics 6 днів тому

    This is a pointless video, and it just goes to show how little the so called experts know about what people are going through. I'm an ex ICU COVID19 patient who was hospitalised (UK) in April 2020, and I still have not recovered. I still have cardiac, pulmonary, MSK, chronic fatigue, circulation, and cognitive issues cannot be halted, stopped or cured ... I've been back at work since June 2020, and struggle on a faily basis.

  • @saeidr.4274
    @saeidr.4274 6 днів тому

    Rip patient's teeth

  • @user-fv9zk9lz2q
    @user-fv9zk9lz2q 7 днів тому

    Seriously?? Who exactly are you speaking to? What is the lay person supposed to do with this? Tons of medical-speak with no interpretation...not helpful.

  • @rupakdas9545
    @rupakdas9545 7 днів тому

    I was scary 😰

  • @lorettatayor5840
    @lorettatayor5840 8 днів тому

    Thirty thousand dollars for a pain pump. outrageous! the medical industry has given up on their patients.

  • @UniversodasDicasShow
    @UniversodasDicasShow 8 днів тому

    Why didn't he let go of the tourniquet as soon as the blood came on the scalp. Procedure seems to be old-fashioned. I won't repost the video for that. 🫤

  • @RL-zy5zm
    @RL-zy5zm 8 днів тому

    I think with isolated right side hf, u shouldn’t treat it with diuretics cause the systemic bp is already low due to decreased preload of the left ventricle. Instead, inotropes will help the right ventricle to pump more blood and regain the circulation and blood pressure.

  • @patriciacampbell6443
    @patriciacampbell6443 10 днів тому

    I take ketamine IM in the Clinic I go to.

  • @carolined5923
    @carolined5923 10 днів тому

    Surely this is much worse than covid.. yet here we are without an effective vax or treatment to knock out the bacteria

  • @juliaarambula3153
    @juliaarambula3153 10 днів тому

    Notice how the guy in yellow says do you test for x,y,z and the white coat makes it seem like no because it isn’t necessary. For example, brain MRI, EEG etc..

  • @nuggetbtl
    @nuggetbtl 10 днів тому

    My mom says I used to have epilepsy and constant seizures until i was 4. I think it became milder since then but I do remember still having seizures until I was 9. But since that, I have been perfectly healthy and most of my symptoms just disappeared. I went into an MRI a few years ago and the doc said my epilepsy was gone. I still wonder why and how it disappeared out of nowhere.

  • @user-vg7cb7ml4g
    @user-vg7cb7ml4g 10 днів тому

    if you are suffering, research turpentine, it's pine sap essential oil and it works wonders for candida and parasites! They will try to scare you away from it by saying it's dangerous but it is an old time medicine used by many ancestors of the south in North America. All medicine from the pine tree, the cone bark, and leaves are potent medicine and esp helpful for detoxing heavy metals - which (heavy metals) creates environments where candida and viruses can thrive.

  • @maurorodrigues576
    @maurorodrigues576 10 днів тому

    But... what type of medicine is used at those different stages? They weren't quoted

  • @sydpie7938
    @sydpie7938 10 днів тому

    I had both of my feet done for the big toes since I'd always get super painful ingrowns and do my own treatment, decided to just have the removal and its the best decision i couldve made! The shots were the worst part, I didn't look so it felt like it would go in forever, I have a high pain tolerance though so it wasn't too bad, just went on longer than I would've liked lol. The recovery was a little tedious with the daily gauze wraps and soaking the feet, but it wasn't hard to do, all worth it in the end.

  • @ChristianChris14
    @ChristianChris14 11 днів тому

    Jesus is coming back soon so repent also Jesus loves you guys and will never give up on you may God bless you and have a blessed day

  • @bhagjathh.m2256
    @bhagjathh.m2256 11 днів тому

    people with posirasis have abnormal triglycerides level?

  • @RighteousMum
    @RighteousMum 11 днів тому

    Oh boy, why did I feel I needed to see this before the procedure?

  • @AnjorinOmotola
    @AnjorinOmotola 11 днів тому

    God bless you ❤

  • @norah9011
    @norah9011 12 днів тому

    Thank you doc, clear and concise recommendations

  • @LexaTerrestrialx
    @LexaTerrestrialx 12 днів тому

    I pray nobody ever gets this done, this is disgusting, you are removing crucial tissue in the nose for what? allergies? A deviated septum? Fix the septum and let the turbinates regulate back to normal positions, idk the patients situation but this is absolutely dangerous & uncalled for.

  • @terryhenson3350
    @terryhenson3350 13 днів тому

    I am a 71 yr. old woman who walks all over my community. I am older than most of the other people I pass. My blood pressure is good, sometimes a little on the low side. My weight is good and so is my blood work, except for cholesterol, which is: LDL 107, HDL is 78, Triglyceride is102. I had a brief TIA in March of this year. On the scan with contrast, a 6mm aneurysm was discovered, which was an SHA. There was also a tiny one of 2mm. My cholesterol is high, a few numbers over normal. I wore the Holter monitor for 2 weeks and the results were good. At times my heart rate increased sometimes for over 30 seconds several times, but those times were when I was walking 5 miles in 85-90 degree heat. I am on Rosouvastatin 20mg and 81mg aspirin. I took Clopedigrel for 21 days.

  • @shinl1348
    @shinl1348 13 днів тому

    Hi Dr. Miller, was diagnosed with stage 1B, tumor was 1.2 cm. I had chemo, then surgery and undergoing radiation. They found 1.5mm residual disease that was 5-10% estrogen. Do you think Xeolda would be overtreatement in my case? Oncologist is suggesting it but not sure benefits will outweight side effects. I need to make a decision soon and not sure what to do. Any insight is greatly appreciated. Thank you.

  • @Ilikerice-rg6bv
    @Ilikerice-rg6bv 13 днів тому

    In my case early diagnosis was not reliable. I got misdiagnosed with autism when I was 3 because I had delayed speech, didn’t interact with other kids much, and I rocked back and forth a lot. I ended up going to a special preschool for the developmentally delayed and I caught up with my speech and became much more social and my autistic behaviour basically disappeared. When I was reassessed at 6 years old and at 17, my results were that I have ADHD, a severe learning disability, mild sensory issues, and some anxiety. I don’t have a problem reading social cues, I never did I’m just a shy introvert with social anxiety, and I don’t struggle with many of the things people on the spectrum struggle with. For most of my elementary school years I was in special education for my LD and I did very well.

  • @natalie25431
    @natalie25431 13 днів тому

    Marijuana is not the same as it used to be. I've noticed having experienced hypoglycemic episodes after smoking. I didn't check my blood but was not at home and I felt it coming on and next thing I knew I was laying on the pavement with no memory of falling. I must have really dove into low numbers. Anyway, I notice feeling that certain sickly feeling after I smoke. I seriously went unconscious this time which is concerning. I'm not one to make appts. I'm going to check my numbers more closely to see if there's any correlation.

    • @natalie25431
      @natalie25431 13 днів тому

      Wow, I just read some of the comments to the video. Not serious as this subject may be.

  • @lubodimitrov2844
    @lubodimitrov2844 13 днів тому

    Really good!

  • @dJOH445-33
    @dJOH445-33 13 днів тому

    Substance P and vomiting… your doctors are clueless about pain

  • @dJOH445-33
    @dJOH445-33 13 днів тому

    Absolutely true… if you can’t help people live in their caged bodies of hell? It is too much to bare…

  • @dJOH445-33
    @dJOH445-33 13 днів тому

    It’s like losing your entire being and living in a cage you cannot get out of.

  • @judylantz4929
    @judylantz4929 14 днів тому

    Stage 3A due to size of tumour only no Mets…thoracotomy done left upper lobe..followed by chemotherapy and immunotherapy…nothing yet a year later…surgery mentally it is gone

  • @user-cw4yc9yv6e
    @user-cw4yc9yv6e 14 днів тому

    Nekem is sajnis 3 ujjamat vàgtàk ke es helyette nem leget ujjat beuktetni?

  • @Slap_it_in
    @Slap_it_in 15 днів тому

    Tell me what I don't already know...

  • @user-fc7cs9ll1y
    @user-fc7cs9ll1y 15 днів тому

    Looks very painful 😮

  • @saurabhgupta5825
    @saurabhgupta5825 16 днів тому

    Wonderful presentation.

  • @kendraboudreau5889
    @kendraboudreau5889 16 днів тому

    Yes with atherocare you can clear plaque from your arteries

  • @jonblehman
    @jonblehman 17 днів тому

    I'm 50, have tried 10 different antidepressants since my 20s. None worked. I've been on 80 mg/day ketamine buccally for just over a month, and my depression, for the first time in my life, is gone. Not there. At all. Put that in your 'algorithm,' 'doctor.'