Sensitivity Analysis for Multiple Comparisons in Matched Observational Studies through Quadratically Constrained Linear Programming

A sensitivity analysis in an observational study assesses the robustness of significant findings to unmeasured confounding. While sensitivity analyses in matched observational studies have been well addressed when there is a single outcome variable, accounting for multiple comparisons through the existing methods yields overly conservative results when there are multiple outcome variables of interest. This stems from the fact that unmeasured confounding cannot affect the probability of assignment to treatment differently depending on the outcome being analyzed. Existing methods allow this to occur by combining the results of individual sensitivity analyses to assess whether at least one hypothesis is significant, which in turn results in an overly pessimistic assessment of a study's sensitivity to unobserved biases. By solving a quadratically constrained linear program, we are able to perform a sensitivity analysis while enforcing that unmeasured confounding must have the same impact on the treatment assignment probabilities across outcomes for each individual in the study. We show that this allows for uniform improvements in the power of a sensitivity analysis not only for testing the overall null of no effect, but also for null hypotheses on \textit{specific} outcome variables while strongly controlling the familywise error rate. We illustrate our method through an observational study on the effect of smoking on naphthalene exposure

Historical cohort study examining comparative effectiveness of albuterol inhalers with and without integrated dose counter for patients with asthma or chronic obstructive pulmonary disease

This study was supported financially by an unrestricted grant from Teva Pharmaceuticals, Frazer, PA, USA. The authors thank Jenny Fanstone of Fanstone Medical Communications Ltd., UK, and Elizabeth V Hillyer for medical writing support, funded by Research in Real-Life. We acknowledge with gratitude Dr Ruchir Parikh for his review of and contributions to the manuscript.Peer reviewedPublisher PD

Psychotherapists\u27 Duty to Warn: Ten Years After Tarasoff

This Comment discusses the Tarasoff decisions and subsequent cases defining the scope of the psychotherapists\u27 duty to protect persons other than their patients. It examines the rationale behind A.B. 2900, and assesses the bill\u27s effect upon the Tarasoff-related objections it addresses. In spite of the Governor\u27s veto of A.B. 2900, there is a need for statutory guidelines to clearly and equitably define the scope of the psychotherapists\u27 duty to protect. This Comment proposes a model statute that attempts to strike a favorable balance among the complex, overlapping interests of psychotherapists, patients, and the public