4 ms·

RCT is not all of science. RCT is just one (very powerful) tool for making information quantifiable and for making decisions under uncertainty.

raverbashing 6y ago
This, exactly. The fixation on RCTs has kinda become "a meme" at this point. However it's lives on the line in some situations. Not everything can be double-blind. Not every experiment can be ethically done with a placebo (or done at all). Also the placebo effect is real but it is more pronounced in things like back pain or headaches, not so much in broken bones or aggressive viruses.
- StavrosK 6y ago
  You don't need to have a placebo to do a controlled trial, you can just have a control arm of people you administer nothing to. How are you going to know if you have an improvement if you don't have something to compare your treatment to, though?
  - fhars 6y ago
    You need the placebo for the double blind RCT, which is still kind of the gold standard. But pronating patients is hard to do in a double blind fashion, so it is less of an issue here.
    - gus_massa 6y ago
      The double blind part is very difficult, but at least they can have a randomized control group [1]. It doesn't sound very difficult. Also, in most cases the control group get the "standard" treatment, because "do nothing" (taking literally the GP) is too bad. And you want to be sure that the new treatment is better than the "standard" treatment. [1] A real randomized control group, not an unrelated bunch of guys in another city of France.
    - bobosha 6y ago
      In some cases, the placebo is a currently approved treatment.
  - raverbashing 6y ago
    > How are you going to know if you have an improvement if you don't have something to compare your treatment to, though? Historical data? Past experiments? Sure, they might have biases, but the higher sample size of historical data can help with that. I think (specific) control groups make sense when you're talking about small effects or very specific cases (for example, the control group will undergo the standard treatment instead of the new treatment)
    - gus_massa 6y ago
      Historical data is useful as a rough guideline, but it is very difficult to use to make comparisons. For example: If there is a small Ebola outbreak in New York and you give the patients hydroxychloroquine and the death rate is 80%, is it good or bad?

raverbashing 6y ago

This, exactly. The fixation on RCTs has kinda become "a meme" at this point. However it's lives on the line in some situations. Not everything can be double-blind. Not every experiment can be ethically done with a placebo (or done at all). Also the placebo effect is real but it is more pronounced in things like back pain or headaches, not so much in broken bones or aggressive viruses.

StavrosK 6y ago
You don't need to have a placebo to do a controlled trial, you can just have a control arm of people you administer nothing to. How are you going to know if you have an improvement if you don't have something to compare your treatment to, though?
- fhars 6y ago
  You need the placebo for the double blind RCT, which is still kind of the gold standard. But pronating patients is hard to do in a double blind fashion, so it is less of an issue here.
  - gus_massa 6y ago
    The double blind part is very difficult, but at least they can have a randomized control group [1]. It doesn't sound very difficult. Also, in most cases the control group get the "standard" treatment, because "do nothing" (taking literally the GP) is too bad. And you want to be sure that the new treatment is better than the "standard" treatment. [1] A real randomized control group, not an unrelated bunch of guys in another city of France.
  - bobosha 6y ago
    In some cases, the placebo is a currently approved treatment.
- raverbashing 6y ago
  > How are you going to know if you have an improvement if you don't have something to compare your treatment to, though? Historical data? Past experiments? Sure, they might have biases, but the higher sample size of historical data can help with that. I think (specific) control groups make sense when you're talking about small effects or very specific cases (for example, the control group will undergo the standard treatment instead of the new treatment)
  - gus_massa 6y ago
    Historical data is useful as a rough guideline, but it is very difficult to use to make comparisons. For example: If there is a small Ebola outbreak in New York and you give the patients hydroxychloroquine and the death rate is 80%, is it good or bad?