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Invited Commentary
April 5, 2021

Exploiting Clinical Decision-making Thresholds to Recover Causal Effects From Observational Data: Randomization Without Trials

Author Affiliations
  • 1Department of Medicine, University of California, San Francisco
  • 2Editorial Fellow, JAMA Internal Medicine
  • 3Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
  • 4Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
  • 5Associate Editor, JAMA Internal Medicine
JAMA Intern Med. Published online April 5, 2021. doi:10.1001/jamainternmed.2021.0923

Randomized clinical trials (RCTs) are the gold standard of study design because randomization ensures that differences in outcomes between a treatment and control group reflect the causal effect of treatment. Although RCTs greatly benefit science and society for this reason, they often cannot be conducted because of logistical, ethical, or resource constraints.1 Researchers are thus confronted with many questions left unanswered.

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