3 ms·

> notably randomized controlled trials that compare mortality. Putting people into a control group so you can observe the effects of not treating them might no

> notably randomized controlled trials that compare mortality. Putting people into a control group so you can observe the effects of not treating them might not make it past the ethics committee.

WorkerBee28474 1y ago
You don't not treat the control group. You give the control group the current standard treatment, and you give the experimental group the new trial treatment.
- thayne 1y ago
  In some cases, the "current standard treatment" is no treatment.
  - heavyset_go 1y ago
    In some studies, although not cancer, I've seen treatment offered to both groups, someone in the control at any time can opt into the same treatment the other group receives if they want to. Some people will make the informed decision to not take the treatment, and they are your control.
    - jononor 1y ago
      No longer randomized though, so it brings in confounding factors. Which one then has to try to control for.
      - heavyset_go 1y ago
        Doesn't really change your point, but I should clarify that what I said was wrong, it was anyone in the study could choose not to take the blinded pill that could be placebo or active, they were removed from the study, and were provided with the active experimental drug + compensation as to not punish them for giving or not giving their consent after being sufficiently informed of the risks of either choice.
  - xandrius 1y ago
    Really? That sounds dumb and unethical. Is the standard treatment for a cut a bandage or leaving you to bleed?
    - thayne 1y ago
      If there is no treatment available, then yes, the standard treatment may be nothing, or possibly just trying to make the patient more comfortable until they die.
gus_massa 1y ago
Now everyones agree with you and there are no more cases like https://en.wikipedia.org/wiki/Tuskegee_Syphilis_Study https://en.wikipedia.org/wiki/Tuskegee_Syphilis_Study (hopefuly). In the current trials a part of the subjects get the new experimental drug and the control group get the current state of the art treatment.
- mr_toad 1y ago
  Yes, but when you compare treatments A vs B for trial 1, and then B vs C for trial 2, and then C, vs D for trail 3, you might not get the same results as comparing A vs D, especially when there may have been other changes in between the three trials (different ages, lifestyles etc). This is a real problem when the Minister wants to know if it’s worth spending money on treatments, because all you have is a disjointed set of trials, none of which are necessarily representative of the population at large, or the population wide incidence of the disease (assuming there is even data on that (notifiable illnesses are the exception).
  - bonsai_spool 1y ago
    > Yes, but when you compare treatments A vs B for trial 1, and then B vs C for trial 2, and then C, vs D for trail 3, you might not get the same results as comparing A vs D, especially when there may have been other changes in between the three trials (different ages, lifestyles etc). That's not what happens. Is this just a hypothetical? Everything will be compared to one standard of care, or perhaps two which will have been compared to each other. If a new treatment is much better, then it will become standard of care. Trials cost a lot of money, so they are conducted rationally.
    - thayne 1y ago
      That is what happens if C is developed after B becomes the standard treatment, D after C etc. Suppose D is only slightly less effective than C, but more effective than A, and B, but 100x cheaper, and/or has less bad side effects. If you only compare with C, all you know is it's not as good as C.

> notably randomized controlled trials that compare mortality. Putting people into a control group so you can observe the effects of not treating them might not make it past the ethics committee.

WorkerBee28474 1y ago

You don't not treat the control group. You give the control group the current standard treatment, and you give the experimental group the new trial treatment.

thayne 1y ago
In some cases, the "current standard treatment" is no treatment.
- heavyset_go 1y ago
  In some studies, although not cancer, I've seen treatment offered to both groups, someone in the control at any time can opt into the same treatment the other group receives if they want to. Some people will make the informed decision to not take the treatment, and they are your control.
  - jononor 1y ago
    No longer randomized though, so it brings in confounding factors. Which one then has to try to control for.
    - heavyset_go 1y ago
      Doesn't really change your point, but I should clarify that what I said was wrong, it was anyone in the study could choose not to take the blinded pill that could be placebo or active, they were removed from the study, and were provided with the active experimental drug + compensation as to not punish them for giving or not giving their consent after being sufficiently informed of the risks of either choice.
- xandrius 1y ago
  Really? That sounds dumb and unethical. Is the standard treatment for a cut a bandage or leaving you to bleed?
  - thayne 1y ago
    If there is no treatment available, then yes, the standard treatment may be nothing, or possibly just trying to make the patient more comfortable until they die.

gus_massa 1y ago

Now everyones agree with you and there are no more cases like https://en.wikipedia.org/wiki/Tuskegee_Syphilis_Study https://en.wikipedia.org/wiki/Tuskegee_Syphilis_Study (hopefuly). In the current trials a part of the subjects get the new experimental drug and the control group get the current state of the art treatment.

mr_toad 1y ago
Yes, but when you compare treatments A vs B for trial 1, and then B vs C for trial 2, and then C, vs D for trail 3, you might not get the same results as comparing A vs D, especially when there may have been other changes in between the three trials (different ages, lifestyles etc). This is a real problem when the Minister wants to know if it’s worth spending money on treatments, because all you have is a disjointed set of trials, none of which are necessarily representative of the population at large, or the population wide incidence of the disease (assuming there is even data on that (notifiable illnesses are the exception).
- bonsai_spool 1y ago
  > Yes, but when you compare treatments A vs B for trial 1, and then B vs C for trial 2, and then C, vs D for trail 3, you might not get the same results as comparing A vs D, especially when there may have been other changes in between the three trials (different ages, lifestyles etc). That's not what happens. Is this just a hypothetical? Everything will be compared to one standard of care, or perhaps two which will have been compared to each other. If a new treatment is much better, then it will become standard of care. Trials cost a lot of money, so they are conducted rationally.
  - thayne 1y ago
    That is what happens if C is developed after B becomes the standard treatment, D after C etc. Suppose D is only slightly less effective than C, but more effective than A, and B, but 100x cheaper, and/or has less bad side effects. If you only compare with C, all you know is it's not as good as C.