This article about the paper is likely to be more informative than the paper itself. (https://blogs.bmj.com/bmj/2018/12/13/we-jumped-from-planes-without-parachu

This article about the paper is likely to be more informative than the paper itself. (https://blogs.bmj.com/bmj/2018/12/13/we-jumped-from-planes-without-parachutes-and-lived-to-tell-the-tale/ https://blogs.bmj.com/bmj/2018/12/13/we-jumped-from-planes-w...) The study is an absolutely ingenious way of simultaneously illustrating multiple different challenges that can frustrate randomized controlled clinical trials. Some highlights: > We believe that randomisation is critical to evaluating the benefits and harms of the vast majority of modern therapies, most of which are unlikely to be nearly as effective at achieving their end goal as parachutes are at preventing injury among people jumping from aircraft. > RCTs are vulnerable to pre-existing beliefs about standard of care, whether or not these beliefs are justified > When strong beliefs about the standard of care exist in the community, often only low risk patients are enrolled in a trial, which can unsalvageably bias the results, akin to jumping from an aircraft without a parachute. > even a well conducted RCT can provide misleading results