Surrogate outcomes: That’s not why we play the game

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JAMA Internal Medicine Blog

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Sports fans are familiar with the adage, “that’s why they play the game.” Statistically any one team may seem to be better on paper, but upsets are possible and do happen with some regularity. For baseball, for example, batting averageon-base percentage, and RBIs all matter, but at the end of any game they only matter to the extent that one team scores more runs than the other when the last player is out.

So, too, it is in medical research. We can’t test every intervention to a defining conclusion for fear of wasting money or causing harm, so we aim initially for what are called surrogate outcomes: HDL and cardiac arryhthmia among others. These outcomes can help us gauge the likelihood of success, and see if we are on track to ultimately help patients. But it’s the outcomes of interest to patients–subsequent heart attacks and of course 

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