Selection Bias with Hazard Ratios

Miguel Hernan has a recetn article on the Hazards of Hazard Ratios. The thing that jumped to my attention was his discussion of "depletion of susceptibles". Any intervention can look protective, eventually, if speeds up disease in the susceptible such that the rate of events in that population eventually drops (as all of the members of the population able to have an event have had it).

I think that this element of hazards ratios illustrates two principles:

1) it always makes sense to begin the analysis of a medication at first use or else you can miss a lot

2) In the long run, we are all dead

So the real trick seems to be more focus on good study design and being careful to formulate problems with precision. Quality study design never goes out of style!