This is not Evidence-based Medicine. EBM does not say to we shouldn't care about the mechanism of action. EBM will say that treatments without a randomized control trial can only be weakly recommended. In a perfect EBM world, everything would be strictly tested. You're describing why we have trouble practicing "pure" EBM.
RCT = randomised controlled trial - a trial where some test subjects are given the vaccine and some are given the vaccine, then you follow the subjects and see which ones get COVID and how bad.
There are already a bunch of vaccines going through this process.
Challenge trials is where you purposefully infect subjects. TheY are highlY controversial but according to Oxford, would speed up the research and they are planning to do one.
Randomized controlled trials are great, they are incredibly certain to be right.
But experience has a whole other quality, it is much less reliable but a whole lot more comprehensive. An RCT can only measure effects on what can be used to select a large group of people. It cannot measure the effects of a weird anomaly that is recorded nowhere. Meanwhile experience can extrapolate from a very few examples.
So it is not at all obvious that we should favor RCTs over experience. Because they have very different things they can measure.
Hmm, I read the article as explicitly calling out "clinical trials" (as referenced in the title and abstract) and it makes no reference research studies. I don't understand the distinction between "research studies" and "clinical trials", surely all research studies where an RCT is performed with real patients and real drugs is a clinical trial?
Clinical researchers working for non-profits / universities do, occasionally. I suspect it has become popular recently not because lives are at stake, but because it lets you publish something meaningful without having to run complex, error prone and lengthy experiments.
Regardless of the true reason, these are never carried out before a new drug or treatment is approved (because there is usually one or two studies supporting said treatment, both positive).
And if you have pointers to techniques developed for/by EBM practitioners, I would be grateful. Being a bayesian guy myself and having spent some time reading Lancet, NEMJ and BMJ papers, I'm so far unimpressed, to say the least.
I think all your criticisms of randomized controlled trials (apart from the ethical one) apply to your suggested approach, no?
RCTs are the gold standard for demonstrating efficacy precisely because of the controls. I agree that they're not going to give you enough info about potential side-effects - a thorough monitoring program is definitely necessary for that.
But without RCTs, showing that a drug works would be much harder. How would you weed out the snake oil?
Informationally, this post lands on information regarding randomized controlled trials (RCTs). However, there isn't a specific thesis I can nail down outside of introducing a general audience to the history and philosophy of RCTs. There is some discussion regarding how they aren't a panacea, but its more of an afterthought.
I mean, people have tried doing studies like that for CQ/HCQ. They are riddled with questionable assumptions (that patient groups are similar or treatment regimens are equivalent) that make their conclusions completely unreliable.
In the end we will most likely find that all positive anecdotal evidence found was just confirmation bias. That's why RCTs are so important.
Epidemiology is precisely one of those cases were very often a randomized control trial isn't feasible (or even ethical to begin with). Your argument is self-defeating.
That's why countless time has been spent refining the techniques and methods used to make and understand those studies, and why the vast majority of experts balance different kind of studies while making decisions, not just RCTs.
But the point of RCTs is that you can get unbiased, high quality results without having to rely on "lore" spreading among medical professionals about which treatments are effective and under which circumstances.
Most importantly, a placebo controlled RCT would be unethical for a disease with high mortality rates.
You would run a randomized controlled trial with treatment control (not placebo controlled) when we have an effective treatment. These are about as good as it is assumed placebo effects figure the same in all tested treatment groups.
Hmm -- in usual fashion I haven't read the original post here, but I'm guessing it didn't find that RCT trials that big pharma do are quite as useless as most 'medical studies' generally.
Do you think well-funded RCTs (like those that support vaccine safety) are just as weak as any old observational study?
RCT: randomized controlled trial?
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