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To the Editor: Dr Lynskey and colleagues¹ interpreted their data as providing evidence that cannabis use caused subsequent drug problems through a "gateway" effect.

This study, however, may have been subject to various biases that would negate this interpretation. For example, drug use and problems were measured via uncorroborated self-report, which can be unreliable.² Different individuals, due mainly to different perceptions of social desirability, may tend to either underreport or overreport their experience of drug use and drug problems. Such reporting tendency would generate a spurious association between use of and problems with one drug and use of and problems with another. The importance of the issue of reporting bias may have been generally underestimated in observational epidemiology.³

There are also possible sources of confounding. Both early cannabis use and other drug problems may share common antecedents, and the apparent association between them may simply reflect this. Although the authors . . . [Full Text of this Article]

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