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| == Useful Resources ==
| | {{#restricted:{{6.2 Hill's Criteria}}}}{{NavCard|prev=6.1 Correlation and Causation|next=7.1 Causation, Blame, and Policy}} |
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| <tabber>
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| |-|Lecture Video=
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| <br /><center><youtube>VYLznjXXXCU</youtube></center><br />
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| |-|Discussion Slides=
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| {{LinkCard | |
| |url=https://docs.google.com/presentation/d/1sKDf-GTT_W0kfF8in0U3cTzNZpQJJgHacWgQdTAv8gs/edit?usp=drivesdk
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| |title=Discussion Slides Template
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| |description=The discussion slides for this lesson.}}
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| <br />
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| |-|Handouts and Activities=
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| {{LinkCardInternal
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| |url=:File:Angrist - 2021 - Draft lottery and lifetime earnings.pdf
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| |title=Lifetime Earnings and the Vietnam Era Draft Lottery
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| |description=The first paper the students analyze in the second part of the paper analysis activity.}}
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| {{LinkCardInternal
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| |url=:File:Giuntella and Mazzonna - 2019 - Sunset time and social jetlag.pdf
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| |title=Sunset Time and the Economic Effects of Social Jetlag: Evidence From US Time Zone Borders
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| |description=The second paper the students analyze in the second part of the paper analysis activity.}}
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| <br />
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| |-|Readings and Assignments=
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| {{LinkCardInternal
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| |url=:File:The Environment and Disease Association or Causation - Hill.pdf
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| |title=The Environment and Disease: Association or Causation?
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| |description=Sir Austin Bradford Hill's original presentation of Hill's criteria.}}
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| <br />
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| </tabber>
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| === During Class ===
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| {| class="wikitable" style="margin-left: 0px; margin-right: auto;"
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| |5 Minutes
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| |Introduce the lesson and go over the plan for the day. Make sure people have groups, spokespeople, etc.
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| |15 Minutes
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| |Ask your students the [[#Concept Review|concept review questions]].
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| |25 Minutes
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| |Have your students work through [[#Paper Analysis (Part 2)|the second part of the paper analysis activity in small groups]].
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| |15 Minutes
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| |Have your students discuss [[#Discussion Questions|how to apply Hill's criteria to the social jetlag study]].
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| |15 Minutes
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| |Go over the [[#COVID-19|COVID-19 example]].
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| |5 Minutes
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| |Answer any lingering questions. These activities have a tendency to go long, so some extra wiggle room is left at the end.
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| |}
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| == Lesson Content ==
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| === Concept Review ===
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| What are the three essential elements of a Randomized Controlled Trial?
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| {{BoxAnswer|Random assignment, control group/condition, trial/experimental intervention}}
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| {{BoxCaution|Note that random sampling is not essential to the validity of an RCT. It merely affects the generalizability of the results of the RCT.}}
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| For both of the following hypotheses, what RCT would you use to test it? Why would it be challenging to perform?
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| <ol start=1><li>For a child, does spending more than 22 hours in their home per day over their childhood increase their risk of developing myopia?</li></ol>
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| {{BoxAnswer|It is not hard to imagine an ideal RCT for this, but it is unethical/impractical to perform the intervention.}}
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| <ol start=2><li>On the level of individual towns, does implementing universal basic income reduce the rate of violent crimes in 10 years? In 150 years?</li></ol>
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| {{BoxAnswer|It is conceivable to do an RCT over 10 years, albeit expensive. However, it is hard to do this experiment on a large enough sample. It is also much less practical to track such an experiment over 150 years. It is difficult to randomise the towns.}}
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| === Paper Analysis (Part 2) ===
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| This is a continuation of [[6.1 Correlation and Causation#Paper Analysis (Part 1)|last lesson's paper analysis]], in which we looked at a classic example of a proper RCT. Here, we will look at two more papers in which an RCT is difficult to conduct, but a strong case can still be made about causation based on experimental results.
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| {{BoxCaution|Strictly speaking, the experiments in the following two papers are not RCTs, since the experimenter never performed any intervention. However, their causal conclusions are nearly as strong as an RCT. Hill's criteria, on the other hand, are useful when even this kind of experiment is impossible to do. We will go through an example of Hill's criteria in [[#COVID-19|the COVID-19 example]] below.}}
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| For each of the two papers, students should try to answer the same questions as they did for the paper in [[6.1 Correlation and Causation#Discussion Questions|part 1]].
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| ==== Vietnam War Draft Lottery ====
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| Example of natural experiment, where the intervention and assignment are not performed by the experimenter but by environmental factors.
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| {{LinkCardInternal
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| |url=:File:Angrist - 2021 - Draft lottery and lifetime earnings.pdf
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| |title=Lifetime Earnings and the Vietnam Era Draft Lottery
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| |description=The first paper the students analyze in the second part of the paper analysis activity.}}
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| The students should try to answer the following.
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| <ol start=1><li>What causal relationship is this paper trying to study? What is the hypothesis?</li></ol>
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| {{BoxAnswer|Does being drafted to serve in the military cause one's income to change later in life?}}
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| <ol start=2><li>What, if it exists at all, is the experimental intervention? (i.e., What is the independent variable that is being manipulated)?</li></ol>
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| {{BoxAnswer|Whether one has served in the military (veteran status).}}
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| <ol start=3><li>What is the dependent variable that is being measured (i.e., the variable the researchers anticipate may be affected by the experimental intervention)?</li></ol>
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| {{BoxAnswer|One's lifetime income.}}
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| <ol start=4><li>How is the independent variable manipulated? Are there control and intervention groups? Are those randomly assigned? Is the control condition a good one (only the independent variable is different, with all else kept equal)? Is this an RCT?</li></ol>
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| {{BoxAnswer|The veteran status is manipulated by the Vietnam War draft lottery, which randomly selected young men to serve in the military. The control group consists of young men who were not drafted by the lottery. This seems like a good control, as the selection is supposedly not based on any factor that may introduce systematic bias to one's future income. There are other factors that allow people to get out of the draft. This paper ''attempts'' to account for this. This is a ''natural experiment''.}}
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| <ol start=5><li>What is the result of the experiment?</li></ol>
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| {{BoxAnswer|Veterans earn 15% less than non-veterans long after the draft and the war ended.}}
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| <ol start=6><li>Can the causal relationship in question 1 be concluded from the experimental results? If not, what, if anything, can be concluded? How confident are you in this conclusion?</li></ol>
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| {{BoxAnswer|Being drafted to serve in the military causes a long term reduction in one's income.}}
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| <ol start=7><li>Can you think of an alternative explanation for the data?</li></ol>
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| {{BoxAnswer|Well-connected or wealthier young men may have had an easier time getting out of the draft, which is a possible confound. Unknown confounds are more likely in a natural experiment, where the differences between experimental group and control group are not as tightly controlled as in a deliberately created RCT.}}
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| {{BoxTip|title=Upshot|This is a natural experiment. All the aspects of an RCT are still satisfied, but the randomized selection and intervention process is not performed by the experimenter but by an external agent/natural process.}}
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| ==== Sunset Time and Social Jetlag ====
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| This paper is not technically an RCT but could be argued to have comparable strength.
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| {{LinkCardInternal
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| |url=:File:Giuntella and Mazzonna - 2019 - Sunset time and social jetlag.pdf
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| |title=Sunset Time and the Economic Effects of Social Jetlag: Evidence From US Time Zone Borders
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| |description=The second paper the students analyze in the second part of the paper analysis activity.}}
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| For each of the two papers, students should try to answer the following.
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| <ol start=1><li>What causal relationship is this paper trying to study? What is the hypothesis?</li></ol>
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| {{BoxAnswer|Does an extra hour of natural light in the evening (according to local time) cause a change in one's sleep duration?}}
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| <ol start=2><li>What, if it exists at all, is the experimental intervention? (i.e., What is the independent variable that is being manipulated)?</li></ol>
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| {{BoxAnswer|The time of sunset in one's local time zone.}}
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| <ol start=3><li>What is the dependent variable that is being measured (i.e., the variable the researchers anticipate may be affected by the experimental intervention)?</li></ol>
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| {{BoxAnswer|Sleep duration.}}
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| <ol start=4><li>How is the independent variable manipulated? Are there control and intervention groups? Are those randomly assigned? Is the control condition a good one (only the independent variable is different, with all else kept equal)? Is this an RCT?</li></ol>
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| {{BoxAnswer|People who live on either side of a time zone boundary are considered, since they live geographically close to each other but have a 1-hour difference in sunset time. We may treat those on the east side of a boundary to be the intervention group and those on the west side to be the control group. The people are certainly not randomly assigned to one group or the other, but it is presumed that there are no systematic differences in the populations on either side that would cause a big difference in sleep patterns, other than the time zones. This is not an RCT, but its strength in implying causal relationship may be argued to be comparable to that of an RCT.}}
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| <ol start=5><li>What is the result of the experiment?</li></ol>
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| {{BoxAnswer|Those living in a time zone with one extra hour of daylight in the evening (an earlier sunset time) sleep 19 minutes less on average.}}
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| <ol start=6><li>Can the causal relationship in question 1 be concluded from the experimental results? If not, what, if anything, can be concluded? How confident are you in this conclusion?</li></ol>
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| {{BoxAnswer|Living in a time zone with one extra hour of daylight in the evening causes a 19-minute reduction in average sleep duration.}}
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| <ol start=7><li>Can you think of an alternative explanation for the data?</li></ol>
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| {{BoxAnswer|This is a pretty convincing study, what with the huge representative Census sample and the arbitrary cutoff. However, it's possible that some existing geographic power/wealth differential enabled people one one side of the time zone split to set it at their advantage (e.g. people in cities), leaving the less powerful/wealthy on the darker side (e.g. people in more rural areas). If this occurred, the difference in sleep and health could be due to the pre-existing power or wealth differential, not the time zone.}}
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| ==== Discussion Questions ====
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| In your small group, explain Hill's criteria using aspects of the ''Sunset Time and Social Jetlag'' study as examples.
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| {{BoxAnswer|title=Prior Plausibility|The presence of sunlight and one's daily schedule are well known to affect sleep patterns. If the work schedule is shifted by one hour due to time zone, it should affect sleep patterns as well.}}
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| {{BoxAnswer|title=Temporality/Temporal Sequence|People have lived on one side of the time zone border before they developed this sleep pattern.}}
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| {{BoxAnswer|title=Specificity|The observed effect in sleep times is drastic across the time zone borders, and this effect is not observed elsewhere. This effect was also only observed in people that had to get up early for work.}}
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| {{BoxAnswer|title=Dose-response Curve|The further away one lives from a time zone border (more accurate their sunset/work time is to the natural circadian rhythm), the less pronounced the effect on sleep times becomes. The effect is also absent among unemployed people. See Figure 6 in the paper.}}
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| {{BoxAnswer|title=Consistency Across Contexts|The effect on sleep times is observed across many different time zone borders scattered throughout the US.}}
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| === COVID-19 ===
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| Bad in the olden days, there was a lot of controversy regarding mask wearing policies to combat the spread of COVID-19. Suppose it were very difficult to conduct a randomized controlled trial to study the effect of community mask wearing on COVID spread.
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| {{LinkCardInternal
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| |url=:File:Abaluck et al. - 2022 - Impact of community masking on COVID-19 A cluster.pdf
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| |title=Impact of Community Masking on COVID-19: A Cluster-randomized Trial in Bangladesh
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| |description=Such RCTs have, in fact, been conducted. Here's an example.}}
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| Have your students work in small groups. For each of the Hill's criteria, what evidence, if observed, would support that criterion?
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| {{BoxAnswer|title=Prior Plausibility|Masks physically blocks one's mouth from emitting/receiving virus-ridden aerosols.}}
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| {{BoxAnswer|title=Temporality/Temporal Sequence|Do COVID cases reduce ''after'' a mask mandate has been instituted in an area/business/school?}}
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| {{BoxAnswer|title=Specificity|Is it the case that counties/businesses/schools that implemented a mask mandate have a dramatically reduced case rate compared to those that did not?}}
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| {{BoxAnswer|title=Dose-response Curve|Does the extent of decrease in COVID cases correlate with the percentage of mask wearers in an area?}}
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| {{BoxAnswer|title=Consistency Across Contexts|Is this reduction in cases after a mask mandate observed in many countries/areas/businesses/schools?}}<!-- == Overflow ==
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| <div class="toccolours mw-collapsible mw-collapsed" style="overflow:auto;">
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| <div style="font-weight:bold;line-height:1.6;">Extra content that's not currently part of the official lesson plan.</div>
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| <div class="mw-collapsible-content">
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| === Chinese Restaurant Syndrome ===
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| (This has been a good quiz question when it wasn't a discussion topic.)
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| Starting from the late 1960s, some people in the USA noticed that they had a headache after eating at Chinese restaurants. They attributed their symptoms to the consumption of monosodium glutamate (MSG), a common food additive in East Asian cuisines. "Chinese Restaurant Syndrome" was coined as a term referring to the negative health effects of MSG.
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| {{BoxCaution|"Chinese restaurant syndrome" was the popular term historically used and it highlights the underlying racism and the bias associated with the claims. We will be discussing prejudices and biases in society clouding our sound scientific judgment in a future topic.}}
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| # (4 min) Describe a randomized controlled trial (RCT) that can test the hypothesis that "consumption of MSG causes headaches." {{BoxAnswer|Randomly split the participants into two groups (random assignment). Give one group a MSG-filled meal (experimental condition). Give the other group a meal low in MSG (control condition). Observe if the participants experience a headache after the meal.}}
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| # (10 min) Suppose that for some reason a RCT could not be done, but after some research, the following facts are known.
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| #* MSG also appears in Western cuisine, naturally in tomatoes and artificially added in many processed foods, and Americans who reported Chinese Restaurant Syndrome did not experience such symptoms after eating a Western meal containing MSG.
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| #* People in East Asian countries, who consistently consume meals containing high amounts of MSG, do not report such symptoms.
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| #* No biological pathway is known that connects MSG consumption and headaches.
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| ## (2 min) Why might a RCT not be able to be conducted? {{BoxAnswer|An RCT might not be able to be conducted for a variety of ethical or practical reasons.}}
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| ## (6 min) Each of the three points above can be used as evidence against a causal relationship between MSG consumption and headaches. For each point, discuss which of Hill's criteria for causality is ''not'' satisfied as a result of that fact. {{BoxAnswer|(1) Consistency across different contexts. (2) Dose-response curve and consistency across contexts. (3) Plausible mechanism.}}
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| Based on Hill's Criteria we can say that there is not a general causation between MSG and the symptoms claimed by "Chinese Restaurant Syndrome." See the quote at [https://www.fda.gov/food/food-additives-petitions/questions-and-answers-monosodium-glutamate-msg this link]:
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| : "These adverse event reports helped trigger FDA to ask the independent scientific group Federation of American Societies for Experimental Biology (FASEB) to examine the safety of MSG in the 1990s. FASEB's report concluded that MSG is safe. The FASEB report identified some short-term, transient, and generally mild symptoms, such as headache, numbness, flushing, tingling, palpitations, and drowsiness that may occur in some sensitive individuals who consume 3 grams or more of MSG without food. However, a typical serving of a food with added MSG contains less than 0.5 grams of MSG. Consuming more than 3 grams of MSG without food at one time is unlikely."
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| === Causal Link Brainstorming ===
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| # (5 min) Brainstorm three causal links that you are pretty confident are real without RCT evidence.
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| # (4 min) Why are you confident about these causal links? {{BoxCaution|small=right|Think about causal links in everyday life, like allergies or breaking a glass.}} {{BoxAnswer|There are any number of answers to this question (i.e. Rain clouds cause rain, The sun heats up objects, Exercise causes muscle growth, Heat will melt butter, Pressing the unlock button on your keys unlocks your car etc.)}}
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| # (5 min) Can you come up with a situation where someone might come to the wrong conclusions about these causal links? {{BoxAnswer|Temporality may cause you to draw the wrong conclusions, especially when it is immediate (i.e. In the PlayPosit John talked about the power outage and someone in a family argument and pounding the table and the lights go out; Homeopathic remedies can lead to the belief that the remedy caused the healing; if you are in a parking garage and you unlock with your fob and another car unlocks at the same time or you slam your car door and another car alarm goes off.)}}
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| # (5 min) How might using just one of Hill's criteria lead someone to a wrong conclusion? {{BoxAnswer|For each causal link you can work through the different criteria (i.e. Every time you press the unlock button on your car keys it only unlocks your car, this mechanism works at home, in a parking garage, and on a street, the mechanism works in any context such as rain/sun/night/day, other people can do it, etc.)}}
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| </div></div> --></restricted>{{NavCard|prev=6.1 Correlation and Causation|next=7.1 Causation, Blame, and Policy}}
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| [[Category:Lesson plans]] | | [[Category:Lesson plans]] |