Are Target Trial Emulations the Gold Standard for Observational Studies?

Re: Are Target Trial Emulations the Gold Standard for Observational Studies?

“…We would like to object to the arguments made by Pearce and Vandenbroucke 1 because they criticize a strawman. The misrepresentation they refute is that “(Target Trial Emulations [TTE])… assumes any causal analysis (…) has to be framed within this (randomized clinical trial) paradigm, focusing on a single ‘ideal’ study.” There is no such requirement: TTE does not impose restrictions on the number of studies to address a specific causal question, nor on the choice of design to emulate the target trial(s).…”

Are Target Trial Emulations the Gold Standard for Observational Studies?: The Authors Respond

“…We wish it were true that we were just criticizing a “straw man.” If the target trial emulation approach was merely that one should have clear research questions, and that it is good to think about how they would be approached by a randomized controlled trial (RCT), then we agree, but these are not new ideas. 2,3 However, the advocates of the target trial emulation approach are going much further than this, with studies being judged by how target trial emulation-like they are. 4,5 It is argued that one should construct a study that emulates the target trial as closely as possible, and that this is a prerequisite for causal inference.…”

“…There are other examples like this, 2 where the target-trial emulation approach can never produce valid effect estimates. In contrast, there are a number of other approaches, 13 including the test-negative design, difference-in-differences, regression discontinuity, triangulation, and Mendelian randomization, which can readily deal with these situations, and which have been shown to produce results consistent with RCTs.…”

The Causal Effects of Causal Inference Pedagogy

“…All commentaries acknowledge the value of imagining hypothetical randomized trials in at least some aspects of study design. 1–3 Pearce and Vandenbroucke raise concerns about how target trial emulation has been operationalized and how prominent case studies may affect training and general practice if details of the particular applications were widely adopted. 1 Their concerns center on how target trial emulation has been or could be implemented, and are not fundamentally critiques of the formal foundations.…”

“…1–3 Pearce and Vandenbroucke raise concerns about how target trial emulation has been operationalized and how prominent case studies may affect training and general practice if details of the particular applications were widely adopted. 1 Their concerns center on how target trial emulation has been or could be implemented, and are not fundamentally critiques of the formal foundations. De Stavola et al 2 make this distinction in their commentary while underscoring how transparency and rigor can be increased by embracing a target trial framework.…”