32 ms·
> Calling the investigatory and experiential evidence of thousands of highly-trained doctors (some of whom pioneered the standard of care for covid) as "weak ev
by mlyle 5y ago
> Calling the investigatory and experiential evidence of thousands of highly-trained doctors (some of whom pioneered the standard of care for covid) as "weak evidence" is something that only somebody carrying water for large pharmaceutical companies would say.
Keep in mind that bleeding with leeches was once the standard of care-- based on clinical intuition and observational evidence.
People-- even very smart, well-educated people-- are easily fooled. There is a reason why the RCT is the gold standard.
- nradov 5y agoThe RCT is the gold standard, but observational studies can be sufficient to establish causality when the effect size is large enough with a clear dose response curve. No one has ever conducted an RCT to prove that cigarette smoking causes lung cancer, but we're pretty sure that it does.
- mlyle 5y ago> to establish causality when the effect size is large enough with a clear dose response curve. And when there's some plausible underlying mechanism that can be studied by more rigorous means. Otherwise, observational studies can find correlation, not causation-- and they're not even very robust at that.
- nradov 5y agoNo the dose response curve alone can be sufficient. Remember that the FDA has approved multiple SSRI drugs for treating clinical depression despite a lack of understanding on the actual mechanism of action. There are several plausible hypotheses but we really don't know why they work.
- mlyle 5y agoA dose response curve in an observational study is irrelevant for establishing causation. There is a dose-response relationship between umbrellas outside and rainfall., but umbrellas do not cause rainfall. And the SSRI point is tangential: they were approved based on RCT evidence. Observing umbrella use and concluding it causes rainfall, even though we don't know of a reason why umbrella use would cause rainfall, is quite different.