Synthetic tabular data are often evaluated by distributional similarity, privacy distance, or train-on-synthetic-test-on-real predictive performance, but these criteria do not ensure validity for causal inference. We show that fully generative tabular synthesizers, including GAN- and LLM-based models, can preserve predictive utility while distorting average treatment effect (ATE) estimates. The failure is structural: ATE preservation requires both a realistic covariate law and an accurate treatment-effect contrast, whereas prediction loss penalizes treatment-effect error only through an overlap-weighted term. We formalize this mismatch through sensitivity and loss-decomposition results, and identify an analogous decomposition in block-level next-token prediction under log loss. Motivated by the tabular causal analysis, we propose a hybrid synthetic-data framework that generates covariates while modeling treatment and outcome mechanisms separately, allowing causal-purpose treatment assignment such as randomized synthetic assignment. We evaluate this framework in three settings: ATE preservation under fully generative versus hybrid synthesis, targeted augmentation for practical positivity problems, and synthetic simulation engines for comparing OR, IPW, AIPW, and TMLE before real-data analysis. Across synthetic and ACTG experiments, hybrid synthesis improves causal fidelity relative to fully generative baselines; LLM-based hybrid synthesis is often more faithful than CTGAN for ATE preservation and finite-sample estimator benchmarking.

A targeted learning (TL) framework is developed to estimate the difference in the restricted mean survival time (RMST) for a clinical trial with time-to-event outcomes. The approach starts by defining the target estimand as the RMST difference between investigational and control treatments. Next, an efficient estimation method is introduced: a targeted minimum loss estimator (TMLE) utilizing pseudo-observations. Moreover, a version of the copy reference (CR) approach is developed to perform a sensitivity analysis for right-censoring. The proposed TL framework is demonstrated using a real data application.

Covariate adjustment is an approach to improve the precision of trial analyses by adjusting for baseline variables that are prognostic of the primary endpoint. Motivated by the SEARCH Universal HIV Test-and-Treat Trial (2013-2017), we tell our story of developing, evaluating, and implementing a machine learning-based approach for covariate adjustment. We provide the rationale for as well as the practical concerns with such an approach for estimating marginal effects. Using schematics, we illustrate our procedure: targeted machine learning estimation (TMLE) with Adaptive Pre-specification. Briefly, sample-splitting is used to data-adaptively select the combination of estimators of the outcome regression (i.e., the conditional expectation of the outcome given the trial arm and covariates) and known propensity score (i.e., the conditional probability of being randomized to the intervention given the covariates) that minimizes the cross-validated variance estimate and, thereby, maximizes empirical efficiency. We discuss our approach for evaluating finite sample performance with parametric and plasmode simulations, pre-specifying the Statistical Analysis Plan, and unblinding in real-time on video conference with our colleagues from around the world. We present the results from applying our approach in the primary, pre-specified analysis of 8 recently published trials (2022-2024). We conclude with practical recommendations and an invitation to implement our approach in the primary analysis of your next trial.

This note introduces a unified theory for causal inference that integrates Riesz regression, covariate balancing, density-ratio estimation (DRE), targeted maximum likelihood estimation (TMLE), and the matching estimator in average treatment effect (ATE) estimation. In ATE estimation, the balancing weights and the regression functions of the outcome play important roles, where the balancing weights are referred to as the Riesz representer, bias-correction term, and clever covariates, depending on the context. Riesz regression, covariate balancing, DRE, and the matching estimator are methods for estimating the balancing weights, where Riesz regression is essentially equivalent to DRE in the ATE context, the matching estimator is a special case of DRE, and DRE is in a dual relationship with covariate balancing. TMLE is a method for constructing regression function estimators such that the leading bias term becomes zero. Nearest Neighbor Matching is equivalent to Least Squares Density Ratio Estimation and Riesz Regression.

We evaluate the performance of targeted maximum likelihood estimation (TMLE) for estimating the average treatment effect in missing data scenarios under varying levels of positivity violations. We employ model- and design-based simulations, with the latter using undersmoothed highly adaptive lasso on the 'WASH Benefits Bangladesh' dataset to mimic real-world complexities. Five missingness-directed acyclic graphs are considered, capturing common missing data mechanisms in epidemiological research, particularly in one-point exposure studies. These mechanisms include also not-at-random missingness in the exposure, outcome, and confounders. We compare eight missing data methods in conjunction with TMLE as the analysis method, distinguishing between non-multiple imputation (non-MI) and multiple imputation (MI) approaches. The MI approaches use both parametric and machine-learning models. Results show that non-MI methods, particularly complete cases with TMLE incorporating an outcome-missingness model, exhibit lower bias compared to all other evaluated missing data methods and greater robustness against positivity violations across. In Comparison MI with classification and regression trees (CART) achieve lower root mean squared error, while often maintaining nominal coverage rates. Our findings highlight the trade-offs between bias and coverage, and we recommend using complete cases with TMLE incorporating an outcome-missingness model for bias reduction and MI CART when accurate confidence intervals are the priority.

Modern deep neural networks are powerful predictive tools yet often lack valid inference for causal parameters, such as treatment effects or entire survival curves. While frameworks like Double Machine Learning (DML) and Targeted Maximum Likelihood Estimation (TMLE) can debias machine-learning fits, existing neural implementations either rely on "targeted losses" that do not guarantee solving the efficient influence function equation or computationally expensive post-hoc "fluctuations" for multi-parameter settings. We propose Targeted Deep Architectures (TDA), a new framework that embeds TMLE directly into the network's parameter space with no restrictions on the backbone architecture. Specifically, TDA partitions model parameters - freezing all but a small "targeting" subset - and iteratively updates them along a targeting gradient, derived from projecting the influence functions onto the span of the gradients of the loss with respect to weights. This procedure yields plug-in estimates that remove first-order bias and produce asymptotically valid confidence intervals. Crucially, TDA easily extends to multi-dimensional causal estimands (e.g., entire survival curves) by merging separate targeting gradients into a single universal targeting update. Theoretically, TDA inherits classical TMLE properties, including double robustness and semiparametric efficiency. Empirically, on the benchmark IHDP dataset (average treatment effects) and simulated survival data with informative censoring, TDA reduces bias and improves coverage relative to both standard neural-network estimators and prior post-hoc approaches. In doing so, TDA establishes a direct, scalable pathway toward rigorous causal inference within modern deep architectures for complex multi-parameter targets.

Interpretable insights from predictive models remain critical in bio-statistics, particularly when assessing causality, where classical statistical and machine learning methods often provide inherent clarity. While Neural Networks (NNs) offer powerful capabilities for modeling complex biological data, their traditional "black-box" nature presents challenges for validation and trust in high-stakes health applications. Recent advances in Mechanistic Interpretability (MI) aim to decipher the internal computations learned by these networks. This work investigates the application of MI techniques to NNs within the context of causal inference for bio-statistics. We demonstrate that MI tools can be leveraged to: (1) probe and validate the internal representations learned by NNs, such as those estimating nuisance functions in frameworks like Targeted Minimum Loss-based Estimation (TMLE); (2) discover and visualize the distinct computational pathways employed by the network to process different types of inputs, potentially revealing how confounders and treatments are handled; and (3) provide methodologies for comparing the learned mechanisms and extracted insights across statistical, machine learning, and NN models, fostering a deeper understanding of their respective strengths and weaknesses for causal bio-statistical analysis.