‘The phrase, “all else being equal,” is crucial, because so often all else is not equal. Simply repeating “RCTs are the gold standard of evidence-based medicine” implies to the naive listener that if it is an RCT then it must be a good study, and reliable, and replicable. It leaves out that most studies have many steps in them, and even if they have a randomization component, they can be badly designed in a step or two, and then lead to misinformation. Then there is the very uncomfortable fact that, so often, RCTs can’t even be replicated, and so often contradict each other, as anyone who has followed RCTs done on their own medical condition often sadly finds out. …. ‘
We seem to read frequently that scientific evidence in medicine is no good if it does not come from randomized clinical trials. This is not really the case, and has never been the case. Norman Doidge, psychiatrist, psychoanalyst, and author of The Brain That Changes Itself and The Brain’s Way of Healing explains how medical science really works, and fails to work.
There are big issues discussed in the article pertaining to research designs, controls, confounds, randomization, statistics, bias, incentive and deception which anyone using scientific evidence to make a judgment or buttress an argument should understand. All scientific evidence is underdetermined. One study does not establish a case; it only points in a certain direction.
An earlier article by Doidge was on HCQ and the campaign against it. Doidge disputed Fauci’s claim that HCQ did not work because evidence in its favor was only anectdotal, and the studies had not been done according to the random controlled paradigm, the alleged ‘gold standard.”
Scientific evidence, production, evaluation and interpretation is way more complicated than that. Claiming that RCT are the only method to gain scientific understanding shows a limited knowledge of the history of science. This has been pointed out by Dr. Harvey Risch in several places, in his defence of HCQ for early stage treatment and prophylactic use for Covid-19. So, you seem to be implicitly aligning yourself with Fauci’s irrational position.
Below are other references:
Volume 210, August 2018, Pages 2-21
Understanding and misunderstanding randomized controlled trials
Evidence for Health Decision Making Beyond Randomized, Controlled Trials
- Thomas R. Frieden, M.D., M.P.H.
“But drug companies are big businesses, and when they bring a drug to market, they do studies that display an aptitude for not asking questions they don’t want the answer to. Relatively little attention is paid to documenting even short-term side effects in studies. How little? A recent review of 192 randomized control trials, in seven different areas of medicine, showed most randomized control trials for drugs (61%-71%) didn’t deal adequately with short-term drug toxicity, and those that dealt with it devoted the same amount of page space, in the published articles, as was taken up by listing the author’s credentials. And of course we can only learn of the long-term side effects decades later.”