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By Michel A. Ibrahim

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Both approaches can be faulted. He who is satisfied with a method just because it appears to work may be accused of superficiality. O n the other hand, he who develops theories as to why it should or should not work is in danger of bias due to preconceptions, and it is bias against which Dr. Feinstein's arguments are mostly directed. At the outset, his paper extols the superiority of the experimental method over the case-control method. It would be heresy to deny this. But I think it is irrelevant, because this meeting is about one of the two chief observational, or nonexperimental methods, and the proper comparison is with the method known as the prospective, longitudinal, or cohort method.

3. Feinstein AR: Clinical biostatistics—XX. The epidemiologic trohoc, the ablative risk ratio, and 'retrospective' research. Clin Pharmacol Therapeut 14: 291-307, 1973 Feinstein AR: Clinical Biostatistics. St. Louis: Mosby, 1977 Sartwell P E : Retrospective studies: a review for the clinician. Ann Int Med 8 1 : 381-386, 1974 J Chron Dis Vol. 32, pp. 45 to 49 Pergamon Press Ltd 1979. Printed in Great Britain DISCUSSION FOLLOWING Drs. FEINSTEIN A N D SARTWELL LILIENFELD: Dr. e. the size of the odds ratio, in evaluating the bias.

It is appearing in the correspondence columns in British medical journals in a context which implies that case-control studies are of no earthly use. I think that we as a group ought to agree to d r o p the term 'trohoc'. D. 3 2 - 1 / 2 — D 45 46 Discussion FEINSTEIN: I d o not think it should be dropped without a better replacement. VESSEY: I think the term was first used in a paper of Dr. Feinstein's which made a very ferocious attack on the case-control approach and which had a very facetious title.

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