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For mutations that increase disease predisposition in both sexes, the imbalance in selection pressures can greatly increase the effect of the allele within the sex that experiences a greater fitness cost of carrying the allele.
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In addition, randomization by a sequence of random numbers may result in selection bias and may lead to imbalance in groups.
This may in part be explained by imbalances in the selection of subsequent treatment regimens with respect to histological subtypes.
Ohno (1967) suggested that this imbalance in gene dosage would result in selection for a dosage compensation mechanism to restore expression of the single X or Z chromosome in the heterogametic sex to the diploid level that existed before degradation of the Y or W gene content.
He added, however, that if there is any imbalance in his program's guest selection, it is not intentional.
Moreover, considering different levels of imbalance, dynamic selection methods secure higher ranks than other alternatives.
There may be concerns about selection bias due to the imbalance in the numbers of children for whom blood samples were available.
The former scenario is more plausible though, as in the course of sex chromosome evolution, dosage imbalance in the heterogametic sex should have increasingly experienced counter-selection.
In observational studies, overt selection bias occurs when there is an imbalance in the characteristics of patients assigned to the treatment or control groups and these characteristics also influence the outcome [4, 5].
Whether reduced incidence of RB1 allelic imbalance in lymph node as well as distant metastasis indicates clonal selection or presents an acquired phenomenon [ 25] remains an open issue.
No other study design rivals the RCT's ability to eliminate selection bias and reduce the risk of a serious imbalance in known and unknown factors that could influence outcomes (when the randomization procedure is executed properly).
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