Can Covid-19 be effectively over?

Here is a possibility for Covid-19.

There is evidence that it could be over effectively, with either Ivermectin, or a Hydroxychloroquine (HCQ) + zinc regime. The evidence on the efficacy of the latter for early stage treatment and prophylaxis is incredibly strong now. See: COVID-19 Treatment – Analysis of 107 global studies, with many showing high effectiveness for early treatment 




107 studies (62 peer reviewed)
COVID deaths: 970,478
Global HC Q studies. PrEP, PEP, and early treatment studies show efficacy, while late treatment shows mixed results.

There is something incredibly rotten in various health bureaucracies. This doctor outlines a case of malfeasance going back decades, driven by ruthless profit making: It rings true to me.

With respect to Hydroxychlorquine, there are 107 studies now. Some are good, some are not so good; some appear designed to fail, and a couple were entirely fraudulent, but overall, the evidence to me says that authorities are killing thousands of people with their approach in various countries, and saving thousands in others. Some of these authorities are undoubtedly rotten to the core, and some are just embracing group think and looking at bad, bad science.

My friend Elizabeth Woodworth has written about the Hydroxychloroquine issues:

  1. The Battle for Pandemic Sanity: Hydroxychloroquine Efficacy vs. Its Suppression By Elizabeth Woodworth, September 17, 2020
  2. Remdesivir for Covid-19: $1.6 Billion for a “Modestly Beneficial” Drug? By Elizabeth Woodworth, August 27, 2020
  3. Leaked: “Deadly” Hydroxychloroquine (HCQ) to treat Covid 19: How the World’s Top Medical Journals, The Lancet and NEJM, Were Cynically Exploited by Big Pharma By Elizabeth Woodworth, August 13, 2020
  4. Academia Stoops to Defamation over Hydroxychloroquine (HCQ). Groundless Accusations against 2 World-class Scientists By Elizabeth Woodworth, August 09, 2020
  5.  The Media Sabotage of Hydroxychloroquine Use for COVID-19: Doctors Worldwide Protest the Disaster By Elizabeth Woodworth, June 30, 2020

In lieu of Hydroxychloroquine, the cheap supplements Quercitin, Zinc, Vitamins D3 and C, and any others you might choose to throw into the mix are, to a high degree of probability, quite protective. Quercitin, a bioflavinoid, is in various fruits and vegetables, but I like to keep my sugar intake low, so use a supplement. Even the evil Dr. Fauci is recommending D and C now. Zinc is well supported as an anti-viral plus.

This is speculation of course, but we may not get a true second wave. It is possible that there is enough pre-existing T-cell immunity (for instance, see ) and enough natural immunity (strong immune system – nutrition, stress levels, sleep, genetics, epi-genetics, …) that the infection has peaked in many places, and is now sputtering with a long tail of low deaths. It is to be hoped that such is the case. I wrote this a few days ago:

Diagnosis of cases creeping up, deaths staying low. Reasons? Varied I am sure. However, that long tail on death statistics still represents lives lost unnecessarily.

Not all countries show the same pattern, but if you break the numbers out regionally, things become a little clearer. Areas that have not had bad infection rates start to show worse numbers, and this can make the overall country statistics look like a second wave is occurring, but this may only be a new region starting to develop cases. Speculation again. In any case, this may be what we are seeing with the case numbers.

None of this says that if we are in a vulnerable category – age, existing co-morbidities – we should relax our vigilance, our efforts to control infection. I believe in the efficacy of social distances, limited contacts, wearing a mask when I can’t keep my distance, keeping out of poorly ventilated spaces, and recreating out-of-doors. Also, even if you are not likely to be vulnerable, you can still transmit the infection to those who are. Anything you can do to reduce your personal viral load is to the good. Anything you can do to reduce any viral inoculum you are transmitting is to the good. This is not just the flu in a number of dimensions. See for instance: and also



Philosophy of Mind – The Stanford Encyclopedia of Philosophy

A bibliography of articles on the philosophy of mind and related topics found in The Stanford Encyclopedia of Philosophy


  1. Avramides, Anita. “Other Minds.” In The Stanford Encyclopedia of Philosophy, edited by Edward N. Zalta, Summer 2019. Metaphysics Research Lab, Stanford University, 2019.
  2. Barlassina, Luca, and Robert M. Gordon. “Folk Psychology as Mental Simulation.” In The Stanford Encyclopedia of Philosophy, edited by Edward N. Zalta, Summer 2017. Metaphysics Research Lab, Stanford University, 2017.
  3. Bickle, John, Peter Mandik, and Anthony Landreth. “The Philosophy of Neuroscience.” In The Stanford Encyclopedia of Philosophy, edited by Edward N. Zalta, Fall 2019. Metaphysics Research Lab, Stanford University, 2019.
  4. Brook, Andrew. “Kant’s View of the Mind and Consciousness of Self.” In The Stanford Encyclopedia of Philosophy, edited by Edward N. Zalta, Spring 2020. Metaphysics Research Lab, Stanford University, 2020.
  5. Gertler, Brie. “Self-Knowledge.” In The Stanford Encyclopedia of Philosophy, edited by Edward N. Zalta, Spring 2020. Metaphysics Research Lab, Stanford University, 2020.
  6. Goff, Philip, William Seager, and Sean Allen-Hermanson. “Panpsychism.” In The Stanford Encyclopedia of Philosophy, edited by Edward N. Zalta, Summer 2020. Metaphysics Research Lab, Stanford University, 2020.
  7. Hatfield, Gary. “René Descartes.” In The Stanford Encyclopedia of Philosophy, edited by Edward N. Zalta, Summer 2018. Metaphysics Research Lab, Stanford University, 2018.
  8. Jacob, Pierre. “Intentionality.” In The Stanford Encyclopedia of Philosophy, edited by Edward N. Zalta, Winter 2019. Metaphysics Research Lab, Stanford University, 2019.
  9. Kraut, Richard. “Plato.” In The Stanford Encyclopedia of Philosophy, edited by Edward N. Zalta, Fall 2017. Metaphysics Research Lab, Stanford University, 2017.
  10. Kulstad, Mark, and Laurence Carlin. “Leibniz’s Philosophy of Mind.” In The Stanford Encyclopedia of Philosophy, edited by Edward N. Zalta, Fall 2020. Metaphysics Research Lab, Stanford University, 2020.
  11. Levin, Janet. “Functionalism.” In The Stanford Encyclopedia of Philosophy, edited by Edward N. Zalta, Fall 2018. Metaphysics Research Lab, Stanford University, 2018.
  12. Liao, Shen-yi, and Tamar Gendler. “Imagination.” In The Stanford Encyclopedia of Philosophy, edited by Edward N. Zalta, Summer 2020. Metaphysics Research Lab, Stanford University, 2020.
  13. Lorenz, Hendrik. “Ancient Theories of Soul.” In The Stanford Encyclopedia of Philosophy, edited by Edward N. Zalta, Summer 2009. Metaphysics Research Lab, Stanford University, 2009.
  14. Lycan, William. “Representational Theories of Consciousness.” In The Stanford Encyclopedia of Philosophy, edited by Edward N. Zalta, Fall 2019. Metaphysics Research Lab, Stanford University, 2019.
  15. Michaelian, Kourken, and John Sutton. “Memory.” In The Stanford Encyclopedia of Philosophy, edited by Edward N. Zalta, Summer 2017. Metaphysics Research Lab, Stanford University, 2017.
  16. Pitt, David. “Mental Representation.” In The Stanford Encyclopedia of Philosophy, edited by Edward N. Zalta, Spring 2020. Metaphysics Research Lab, Stanford University, 2020.
  17. Ravenscroft, Ian. “Folk Psychology as a Theory.” In The Stanford Encyclopedia of Philosophy, edited by Edward N. Zalta, Summer 2019. Metaphysics Research Lab, Stanford University, 2019.
  18. Rescorla, Michael. “The Computational Theory of Mind.” In The Stanford Encyclopedia of Philosophy, edited by Edward N. Zalta, Fall 2020. Metaphysics Research Lab, Stanford University, 2020.
  19. Robinson, Howard. “Dualism.” In The Stanford Encyclopedia of Philosophy, edited by Edward N. Zalta, Fall 2020. Metaphysics Research Lab, Stanford University, 2020.
  20. Scarantino, Andrea, and Ronald de Sousa. “Emotion.” In The Stanford Encyclopedia of Philosophy, edited by Edward N. Zalta, Winter 2018. Metaphysics Research Lab, Stanford University, 2018.
  21. Schwitzgebel, Eric. “Belief.” In The Stanford Encyclopedia of Philosophy, edited by Edward N. Zalta, Fall 2019. Metaphysics Research Lab, Stanford University, 2019.
  22. Shields, Christopher. “Aristotle.” In The Stanford Encyclopedia of Philosophy, edited by Edward N. Zalta, Fall 2020. Metaphysics Research Lab, Stanford University, 2020.
  23. Siewert, Charles. “Consciousness and Intentionality.” In The Stanford Encyclopedia of Philosophy, edited by Edward N. Zalta, Spring 2017. Metaphysics Research Lab, Stanford University, 2017.
  24. Singer, P. N. “Galen.” In The Stanford Encyclopedia of Philosophy, edited by Edward N. Zalta, Winter 2016. Metaphysics Research Lab, Stanford University, 2016.
  25. Smart, J. J. C. “The Mind/Brain Identity Theory.” In The Stanford Encyclopedia of Philosophy, edited by Edward N. Zalta, Spring 2017. Metaphysics Research Lab, Stanford University, 2017.
  26. Smith, Joel. “Self-Consciousness,” July 13, 2017.
  27. ———. “Self-Consciousness.” In The Stanford Encyclopedia of Philosophy, edited by Edward N. Zalta, Summer 2020. Metaphysics Research Lab, Stanford University, 2020.
  28. Stoljar, Daniel. “Physicalism.” In The Stanford Encyclopedia of Philosophy, edited by Edward N. Zalta, Winter 2017. Metaphysics Research Lab, Stanford University, 2017.
  29. “Table of Contents (Stanford Encyclopedia of Philosophy).” Accessed September 19, 2020.
  30. Tanney, Julia. “Gilbert Ryle,” December 18, 2007.
  31. Thagard, Paul. “Cognitive Science.” In The Stanford Encyclopedia of Philosophy, edited by Edward N. Zalta, Spring 2019. Metaphysics Research Lab, Stanford University, 2019.
  32. Tye, Michael. “Qualia.” In The Stanford Encyclopedia of Philosophy, edited by Edward N. Zalta, Summer 2018. Metaphysics Research Lab, Stanford University, 2018.
  33. Van Gulick, Robert. “Consciousness.” In The Stanford Encyclopedia of Philosophy, edited by Edward N. Zalta, Spring 2018. Metaphysics Research Lab, Stanford University, 2018.
  34. Wilson, Robert A., and Lucia Foglia. “Embodied Cognition.” In The Stanford Encyclopedia of Philosophy, edited by Edward N. Zalta, Spring 2017. Metaphysics Research Lab, Stanford University, 2017.
  35. Wu, Wayne. “The Neuroscience of Consciousness.” In The Stanford Encyclopedia of Philosophy, edited by Edward N. Zalta, Winter 2018. Metaphysics Research Lab, Stanford University, 2018.

The Myth of Objectivity

“The ideal of a knowledge embodied in strictly impersonal statements now appears self-contradictory, meaningless, a fit subject for ridicule. We must learn to accept as our ideal a knowledge that is manifestly personal.”



A bibliography on “The Myth of Objectivity”

  1. Rock Paper Shotgun. “A Philosophical Perspective On The Myth Of Objectivity.” Accessed September 18, 2020.
  2. admin. “Critical Thinking Part 1: The Myth of Objectivity.” Dr. Marc D. Baldwin (blog), September 17, 2011.
  3. Alliger, George M., and Paul J. Hanges. “Objectivity and Science: Reply to Kukla.” Journal of Personality and Social Psychology 47, no. 3 (1984): 676–79.
  4. Armitage, Andrew; “Truths and Realities: An Autobiographical Account of a Researcher’s View from the inside.” Education-Line, December 12, 2007.
  5. Armstrong, J. Scott. “Advocacy as a Scientific Strategy: The Mitroff Myth.” Academy of Management Review 5, no. 4 (October 1, 1980): 509–11.
  6. Bowden, John A., and Pamela J. Green. “Relationality and the Myth of Objectivity in Research Involving Human Participants.” Researching Practice, January 1, 2010, 105–12.
  7. Cohen, Amy. “Copyright Law and the Myth of Objectivity: The Idea-Expression Dichotomy and the Inevitability of Artistic Value Judgments.” 66 Indiana Law Journal 175 (1990) 66, no. 1 (January 1, 1990).
  8. The Aggie. “Column: Myth of Objectivity,” March 14, 2013.
  9. TED Blog. “Dan Gilbert on the Myth of Objectivity,” April 17, 2006.
  10. The Runner. “Dropping the Myth of Objectivity in Journalism,” November 19, 2018.
  11. Duffy, Margaret, Esther Thorson, Fred Vultee, Esther Thorson, and Fred Vultee. “All Communication Is Persuasive: Exploding the Myth of Objectivity.” Persuasion Ethics Today. Routledge, December 7, 2015.
  12. Epistemology: A Guide. John Wiley & Sons, 2013.
  13. Dissident Mama. “Fake News, Part 1: The Myth of Objectivity,” March 27, 2017.
  14. “Feminist Epistemology.” In The SAGE Encyclopedia of Qualitative Research Methods. 2455 Teller Road, Thousand Oaks California 91320 United States: SAGE Publications, Inc., 2008.
  15. Gadamer, Hans-Georg. Truth and Method. Revised Edition. London ; New York: Bloomsbury Academic, 2004.
  16. Gannon, Kevin. “Objective History Is Impossible. And That’s a Fact.” The Tattooed Professor (blog), May 9, 2016.
  17. González Ramos, Ana M., Beatriz Revelles Benavente, Ana M. González Ramos, and Beatriz Revelles Benavente. “Excellence in Science: A Critical Affirmative Response.” Cadernos de Pesquisa 47, no. 166 (December 2017): 1372–94.
  18. Kara, Helen. “Not Spock! The Myth of ‘Objectivity’ Damages Public Trust in Science.” Helen Kara (blog), May 13, 2020.
  19. Kukla, Andre. “The Structure of Self-Fulfilling and Self-Negating Prophecies:” Theory & Psychology, August 19, 2016.
  20. Malpas, Jeff. “Hans-Georg Gadamer.” In The Stanford Encyclopedia of Philosophy, edited by Edward N. Zalta, Fall 2018. Metaphysics Research Lab, Stanford University, 2018.
  21. ———. “Hans-Georg Gadamer.” In The Stanford Encyclopedia of Philosophy, edited by Edward N. Zalta, Fall 2018. Metaphysics Research Lab, Stanford University, 2018.
  22. Mayo. “The Myth of ‘The Myth of Objectivity” (i).” Error Statistics Philosophy (blog), September 18, 2016.
  23. Mayo, Deborah G., ed. “The Myth of ‘The Myth of Objectivity.’” In Statistical Inference as Severe Testing: How to Get Beyond the Statistics Wars, 221–38. Cambridge: Cambridge University Press, 2018.
  24. Mikulecky, Donald C. “Causality and Complexity: The Myth of Objectivity in Science.” Chemistry & Biodiversity 4, no. 10 (2007): 2480–91.
  25. ———. “Causality and Complexity: The Myth of Objectivity in Science.” Chemistry & Biodiversity 4, no. 10 (October 2007): 2480–91.
  26. Miller, Arthur. “The Myth of Objectivity in Legal Research and Writing.” Catholic University Law Review 18, no. 3 (January 1, 1969): 290–307.
  27. Mitroff, Ian I. “The Myth of Objectivity OR Why Science Needs a New Psychology of Science.” Management Science 18, no. 10 (1972): 613–18.
  28. ———. “The Myth of Objectivity OR Why Science Needs a New Psychology of Science.” Management Science 18, no. 10 (June 1, 1972): B-613.
  29. ———. “The Myth of Objectivity OR Why Science Needs a New Psychology of Science.” Management Science 18, no. 10 (June 1, 1972): B-613–B-618.
  30. Morgan, Gareth. “Accounting as Reality Construction: Towards a New Epistemology for Accounting Practice.” Accounting, Organizations and Society 13, no. 5 (January 1, 1988): 477–85.
  31. “Mr. Mailer and the Myth of Objectivity | News | The Harvard Crimson.” Accessed September 18, 2020.
  32. 50 Myths of the Internet. “Myth #19: Search Engines Provide Objective Results.” Accessed September 18, 2020.
  33. “News: Beyond the Myth of Objectivity | Center for Media Literacy | Empowerment through Education | CML MediaLit Kit TM |.” Accessed September 18, 2020.
  34. Ormandy, Roman. “The Myth of Objectivity.” Medium, February 26, 2017.
  35. “Our Mental Prison: The Myth of ‘Objective’ Knowledge.” Accessed September 18, 2020.
  36. ResearchGate. “(PDF) The Myth of Objectivity in the News and Internet Journalism in Turkey.” Accessed September 18, 2020.
  37. Piippo, John. “The Myth of Objectivity.” Accessed September 18, 2020.
  38. Pm, Allen, and Varga L. “Complexity: The Co-Evolution of Epistemology, Axiology and Ontology.” Nonlinear Dynamics, Psychology, and Life Sciences 11, no. 1 (January 1, 2007): 19–50.
  39. Podsakoff, Philip M., Scott B. MacKenzie, Jeong-Yeon Lee, and Nathan P. Podsakoff. “Common Method Biases in Behavioral Research: A Critical Review of the Literature and Recommended Remedies.” Journal of Applied Psychology 88, no. 5 (2003): 879–903.
  40. Poerksen, Bernhard. “Theory Review the Ideal and the Myth of Objectivity.” Journalism Studies 9, no. 2 (April 1, 2008): 295–304.
  41. Polanyi, Michael. Personal Knowledge. Routledge, 2012.
  42. ———. The Study of Man. Martino Publishing, 2014.
  43. ———. The Tacit Dimension. University of Chicago Press, 2009.
  44. Polanyi, Michael, and Harry Prosch. Meaning. University of Chicago Press, 2008.
  45. Research, RTi. “Algorithms and the Myth of Objectivity.” RTi Research (blog), October 17, 2017.
  46. Columbia Journalism Review. “Re-Thinking Objectivity.” Accessed September 18, 2020.
  47. Romagnano, Lew. “The Myth of Objectivity in Mathematics Assessment.” Mathematics Teacher 94, no. 1 (2001): 31–37.
  48. ———. “The Myth of Objectivity in Mathematics Assessment.” Mathematics Teacher 94, no. 1 (2001): 31–37.
  49. Sæther, Ole A. “The Myth of Objectivity—Post-Hennigian Deviations.” Cladistics 2, no. 1 (1986): 1–13.
  50. Segal, L. “The Myth of Objectivity,” 2001.
  51. Segal, Lynn. “The Myth of Objectivity.” In The Dream of Reality: Heinz von Foerster’s Constructivism, edited by Lynn Segal, 5–25. New York, NY: Springer, 2001.
  52. Soler, Viviana. “Scientific Communication and the Nature of Science: An Illustration of Oscillations from Researcher’s Proximity to Researcher’s Distance in Scientific Titles and Its Pedagogical Implications.” Colombian Applied Linguistics Journal 16, no. 2 (December 2014): 291–302.
  53. “The Dream of Reality.” In Wikipedia, February 1, 2020.
  54. Drishtikone. “The Fallacy of Objectivity.” Accessed September 18, 2020.
  55. Psychology Today. “The Myth of Objectivity.” Accessed September 18, 2020.
  56. “The Myth of Objectivity.” Accessed September 18, 2020.
  57. ResearchGate. “The Myth of Objectivity.” Accessed September 18, 2020.
  58. “The Myth of Objectivity in Mathematics Assessment – ProQuest.” Accessed September 18, 2020.
  59. “Twitter Forces Media to Confront the Myth of Objectivity – Gigaom.” Accessed September 18, 2020.
  60. VideoWordMadeFlesh. “The Myth of Objectivity or: Why I Hate Fight Club.” Video Word Made Flesh (blog), March 1, 2012.
  61. Wilson, Hamish J. “The Myth of Objectivity: Is Medicine Moving towards a Social Constructivist Medical Paradigm?” Family Practice 17, no. 2 (April 1, 2000): 203–9.


Social Epistemology

From the Stanford Encyclopedia of Philosophy


“Until recently, epistemology—the study of knowledge and justified belief—was heavily individualistic in focus. The emphasis was on evaluating doxastic attitudes (beliefs and disbeliefs) of individuals in abstraction from their social environment. Social epistemology seeks to redress this imbalance by investigating the epistemic effects of social interactions and social systems. After giving an introduction, and reviewing the history of the field in sections 1 and 3, we move on to discuss central topics in social epistemology in section 3. These include testimony, peer disagreement, and judgment aggregation, among others. Section 4 turns to recent approaches which have used formal methods to address core topics in social epistemology, as well as wider questions about the functioning of epistemic communities like those in science. In section 5 we briefly turn to questions related to social epistemology and the proper functioning of democratic societies. “

Covid-19 Speculation – Sept 16, 2020

Update 2020-10-11: The trend of deaths going down may be reversing in some places, and needs more investigation. Unfortunately, the main site that I use, Coronavirus Update (Live): 5,304,001 Cases and 340,004 Deaths from COVID-19 Virus Pandemic – Worldometer , does not give the fine-grained breakdown I would like to have. It may be that regional patterns, showing past true case and death rates for a limited geographical area would give a clearer picture, that is obscured by country-wide aggregate figures. Looking at this will be another project for another day.

Looking into Deaths and Cases

The Covid-19 infection appears to be dying down in many, many places. Sometimes infections are going up, but more often they are going down. Deaths are going down a lot in many, many places. There is a caveat: a more thorough survey of Covid-19 statistics from various locations has been done by others; such work needs to be done even more systematically and extensively. The pattern may not be always true. See Coronavirus Update (Live): 5,304,001 Cases and 340,004 Deaths from COVID-19 Virus Pandemic – Worldometer. It is still possible that there will be a resurgence.

If it is the case that infections and deaths are trailing off, what are the possible explanations? There are several possibilities that I can think of: better social distancing and infection control, the virus has mutated to a less deadly strain, those who are most vulnerable are not being put at risk the same way as before, the susceptible have already been infected, there is pre-existing immunity from T-cells and previous Coronoa virus infections, treatment is better, and probably other things. Take your pick. My conjecture: most or all may be playing a role.

Here is a possibility:

Chris Martenson’s X,Y,Z hypothesis says:

X – Natural immunity – nutrition, genetics, epi-genetics, stress, sleep, youth, reduced co-morbidities

Y – long term T-cell immunity from previous Corona virus infections

Z – short term anti-body immunity from Covid-19

The percentages are debatable, but the overall scheme seems sound. We don’t know for sure what we need to have large scale group immunity, but previous estimates may have been on the high side.

Both DrBeen and Dr. Martenson have given their versions of this. Martenson suggested some percentages, just for the sake of argument, knowing that the data was not there.  See:

You have the effectiveness of infection spread measures and possible (likely?) mutation of the virus as factors as well.

There are theories that humidity and that temperature also play a key role in viral suppression. I am not at all certain about the first and think the second seems unlikely looking at worldwide results.

Testing has redefined the term case in an unfortunate way.

The tests are unreliable – false positives and false negative. Testing is showing “cases” increasing wherever testing is widespread, but these counts are something to look at suspiciously. See here: in “Covid Testing: Bad Science Worse Policy.”

Of course the numbers are inaccurate, both over-counts and under-counts, but the overall trend seems somewhat clear. Look at places that have had a high infection per million, that are reasonably small geographically. The infection grows rapidly, and then goes down with a long tail, not reaching zero. Fatalities lag infections, and move to low numbers. Still, this is bad enough.

Country-wide statistics do not show that there are sub-patterns for each region, and each centre of population. The numbers are not always fine-grained enough. It is complex, but the overall trend seems to be an exponential peak, and a gradual fade out in infections and in deaths, a long tail. Treatment is certainly better, so fewer deaths, but maybe people are distancing enough to get a lower viral load and lessened infection, and the vulnerable in care homes are not being sacrificed.

Viral Loads and Inoculum

I have formed the opinion that reduction of viral load is crucial. I listened to a doctor last night making the claim that the research does not show viral load to be a factor, and that even one virion can be enough to cause an infection. This seems highly unlikely to me. She disparages three scientists for their pro-mask position because they were not medical scientists, and then lauds another scientist (Denis Rancourt) for his anti-mask paper, when he is a physicist. He also comes out with the “one virion can infect you” hypothesis.

I tracked down a paper on the “one virion can infect you” claim. Pretty iffy. One study on some other virus in insects, and some statistical massageleading to conclusions. I am not convinced that the results can be generalized. See:

I did not find other studies; such may exist. I did not find a rebuttal; such may also exist.

I am still wearing a mask when I can’t keep my distance. There are those who say that the 2 meter distance is not enough and masks are not protective, and can cherry pick studies to prove their point. I guess we all cherry pick.

Masks may or may not work – I lean to the side of probably do, and risk management  says to me that we should wear them when we cannot keep our distance, or ensure good air circulation. Studies are in conflict on this. Wearing them when driving alone, or when sitting on your front lawn, shows a lack of understanding of how things work.

Will there be a resurgence? Maybe, maybe not. Where I live, in British Columbia, and particularly on Vancouver Island, we have not been hit very hard. So, we may still be subject  to rapid growth if social distancing fails to be practised. I don’t know the long term prognosis. Will it disappear completely as SARS and MERS seemed to do? Deadly infections die out faster than less deadly ones, but this one is not as universally deadly as previously thought.

Diagnosis of cases creeping up, deaths staying low. Reasons? Varied I am sure.There are also some patterns with two humps,bi-modal, so a deeper analysis is required.  When deaths decrease into a long-tail pattern, that still represents lives lost unnecessarily. See

Motivated Reasoning

Biased reasoning? We all do it. Exposure to only some of the evidence? That is the norm. Conflicting studies? Always, in all fields. Poorly done studies, confounded studies, studies with meaningless or uninterpretable variables? Routine. Inability to integrate and interpret voluminous amounts a conflicting and ambiguous evidence? That is the typical case. Reasoning from current beliefs? How could it be otherwise?

Science lurches, sometimes forwards, sometimes off into alternative dimensions.

‘Still a man hears what he wants to hear and disregards the rest.’ — Paul Simon”

Some Graphs Showing a Pattern of Decreasing Deaths

For instance, here are some not unusual patterns:




Also in Australia, a bimodal distribution of cases and deaths. I would like to see this broken down by region.

Even in France, where cases are growing, deaths are not keeping pace. Why is that? Is it an artifact of the amount of testing? I dunno.


Also, places using HCQ for prophylaxis and early stage treatment have in general faired a lot better. There are now 102 studies on it, most showing positive results when taken early, preferably with Zinc. Ivermectin seems to be even better, but I have not found a site that collects studies on that yet.
For HCQ, see, the most comprehensive study aggregation site. Studies will routinely contradict one and other, all are confounded in one way or another.  It is the job of systematic meta-analysis to try to make sense of them all. This is not for the faint of heart, and the methods require a deep understanding of the field, and of very advanced statistics. There have been several meta-analyses of HCQ studies.  Some studies have looked at the wrong thing – late stage infection.


Bibliography for Limitations of Randomized Controlled Trials

  1. “8. 7 Randomised, Double-Blind, Placebo-Controlled Trials | Training Manual | HIV i-Base.” Accessed September 13, 2020.
  2. “8 Advantages and Disadvantages of Experimental Research | FutureofWorking.Com.” Accessed September 13, 2020.
  3. ResearchGate. “A Framework for Development and Evaluation of RCT’s for Complex Interventions to Improve Health | Request PDF.” Accessed September 13, 2020.
  4. “Academy Submits Recommendations for Development of 2020-2025 Dietary Guidelines for Americans.” Accessed September 13, 2020.
  5. admin. “Introduction to Study Designs – Intervention Studies and Randomised Controlled Trials.” Text. Health Knowledge, July 7, 2010.
  6. Admin1. “Trials and Errors: The Limits of Randomised Controlled Trials.” Campbell Collaboration. Accessed September 12, 2020.
  7. DAIC. “Advantages and Disadvantages of Novel Oral Anticoagulants,” July 12, 2016.
  8. Akobeng, A. K. “Understanding Randomised Controlled Trials.” Archives of Disease in Childhood 90, no. 8 (August 1, 2005): 840–44.
  9. Ali, A. B., C. Chapman-Kiddell, and M. M. Reeves. “Current Practices in the Delivery of Parenteral Nutrition in Australia.” European Journal of Clinical Nutrition 61, no. 4 (April 2007): 554–60.
  10. Allen, Ryan W., Prabjit K. Barn, and Bruce P. Lanphear. “Randomized Controlled Trials in Environmental Health Research: Unethical or Underutilized?” PLoS Medicine 12, no. 1 (January 2015): e1001775.
  11. Althouse, Andrew D., Kaleab Z. Abebe, Gary S. Collins, and Frank E. Harrell Jr. “Response to ‘Why All Randomized Controlled Trials Produce Biased Results.’” Annals of Medicine 50, no. 7 (October 3, 2018): 545–48.
  12. “Analyzing Overall Survival in Randomized Controlled Trials with Crossover and Implications for Economic Evaluation. – PDF Download Free.” Accessed September 14, 2020.
  13. Andrews, Keith. “The Limitations of Randomized Controlled Trials in Rehabilitation Research.” Clinical Rehabilitation 5, no. 1 (February 1, 1991): 5–8.
  14. Aronson, Jeffrey K. “Anecdotes as Evidence.” BMJ 326, no. 7403 (June 19, 2003): 1346.
  15. Aronson, Jeffrey K., and Manfred Hauben. “Anecdotes That Provide Definitive Evidence.” BMJ (Clinical Research Ed.) 333, no. 7581 (December 16, 2006): 1267–69.
  16. ResearchGate. “Assessing the Gold Standard — Lessons from the History of RCTs.” Accessed September 14, 2020.
  17. “August 15, 2011 – Chiropractic Resource Organization – Largest Chiropractic News Source.” Accessed September 14, 2020.
  18. Axelrod, David A., and Rodney Hayward. “Nonrandomized Interventional Study Designs (Quasi-Experimental Designs).” In Clinical Research Methods for Surgeons, edited by David F. Penson and John T. Wei, 63–76. Totowa, NJ: Humana Press, 2007.
  19. Bauchner, Howard, and Phil B. Fontanarosa. “Randomized Clinical Trials and COVID-19: Managing Expectations.” JAMA 323, no. 22 (June 9, 2020): 2262–63.
  20. “Benefits and Limitations of Randomized Controlled Trials: I Agree with Deaton and Cartwright « Statistical Modeling, Causal Inference, and Social Science.” Accessed September 13, 2020.
  21. Berger, Robert L, Bartolome R Celli, Anne L Meneghetti, Peter H Bagley, Cameron D Wright, Edward P Ingenito, Anthony Gray, and Gordon L Snider. “Limitations of Randomized Clinical Trials for Evaluating Emerging Operations: The Case of Lung Volume Reduction Surgery.” The Annals of Thoracic Surgery 72, no. 2 (August 1, 2001): 649–57.
  22. Bergman, Jonathan, Anna Nordström, and Peter Nordström. “Overestimation of the Limitations of Randomized Controlled Trials.” Journal of Bone and Mineral Research 34, no. 9 (2019): 1767–68.
  23. Bergqvist, D., M. Björck, J. Säwe, and T. Troëng. “Randomized Trials or Population-Based Registries.” European Journal of Vascular and Endovascular Surgery 34, no. 3 (September 1, 2007): 253–56.
  24. “Beyond Randomized Controlled Trials: A Critical Comparison of Trials with Nonrandomized Studies – Sørensen – 2006 – Hepatology – Wiley Online Library.” Accessed September 11, 2020.
  25. Bhatt, Deepak L., and Cyrus Mehta. “Adaptive Designs for Clinical Trials.” Edited by Jeffrey M. Drazen, David P. Harrington, John J.V. McMurray, James H. Ware, and Janet Woodcock. New England Journal of Medicine 375, no. 1 (July 7, 2016): 65–74.
  26. Bhide, Amar, Prakesh S. Shah, and Ganesh Acharya. “A Simplified Guide to Randomized Controlled Trials.” Acta Obstetricia et Gynecologica Scandinavica 97, no. 4 (2018): 380–87.
  27. “Blog: Three Problems with Randomized Controlled Trials – CDE Alumni Resources.” Accessed September 13, 2020.
  28. Bondemark, Lars, and Sabine Ruf. “Randomized Controlled Trial: The Gold Standard or an Unobtainable Fallacy?” European Journal of Orthodontics 37, no. 5 (October 1, 2015): 457–61.
  29. Boston, 677 Huntington Avenue, and Ma 02115 +1495‑1000. “Salt and Sodium.” The Nutrition Source, July 18, 2013.
  30. Braga, Luis Henrique P., Forough Farrokhyar, and Mohit Bhandari. “Practical Tips for Surgical Research.” Canadian Journal of Surgery 55, no. 2 (April 2012): 132–38.
  31. Braun, Henry. “The Cognitive Outcomes of Liberal Education.” The Andrew W. Mellon Foundation. Boston College, January 4, 2019.
  32. Bulpitt, Christopher J. “The Advantages and Disadvantages of Randomised Controlled Trials.” In Randomised Controlled Clinical Trials, edited by Christopher J. Bulpitt, 379–85. Boston, MA: Springer US, 1996.
  33. Burtless, Gary. “Experimental Economists Win Nobel Prize (and Deserved to Win).” Brookings (blog), October 23, 2019.
  34. Candlish, Jane, M. Dawn Teare, Munyaradzi Dimairo, Laura Flight, Laura Mandefield, and Stephen J. Walters. “Appropriate Statistical Methods for Analysing Partially Nested Randomised Controlled Trials with Continuous Outcomes: A Simulation Study.” BMC Medical Research Methodology 18, no. 1 (October 11, 2018): 105.
  35. Carey, Timothy A., Vyv Huddy, and Robert Griffiths. “To Mix or Not To Mix? A Meta-Method Approach to Rethinking Evaluation Practices for Improved Effectiveness and Efficiency of Psychological Therapies Illustrated With the Application of Perceptual Control Theory.” Frontiers in Psychology 10 (2019).
  36. Carey, Timothy, and William Stiles. “Some Problems with Randomized Controlled Trials and Some Viable Alternatives.” Clinical Psychology & Psychotherapy 23, no. 1 (2016): 87–95.
  37. Students 4 Best Evidence. “Case-Control and Cohort Studies: A Brief Overview,” December 6, 2017.
  38. Catalog of Bias. “Catalogue of Bias,” March 27, 2017.
  39. “Centre for Remote Health Publications – CRH – Centre for Remote Health.” Accessed September 14, 2020.
  40. “CHAPTER 3 Bias in Randomized Controlled Trials,” 2007. /paper/CHAPTER-3-Bias-in-randomized-controlled-trials/fdeb343dfd2e43384eb6987608122c9cb5991b5d.
  41. “Chapter 8: Assessing Risk of Bias in a Randomized Trial.” Accessed September 14, 2020. /handbook/current/chapter-08.
  42. Chen, YUNG-TAI, JUN Chen, WAI-YAN Wong, STEPHEN SHEI-DEI Yang, CHENG-HSING Hsieh, and CHUNG-CHENG Wang. “Is Ureteral Stenting Necessary After Uncomplicated Ureteroscopic Lithotripsy? A Prospective, Randomized Controlled Trial.” The Journal of Urology 167, no. 5 (May 1, 2002): 1977–80.
  43. Chopra, Sameer S. “Industry Funding of Clinical Trials: Benefit or Bias?” JAMA 290, no. 1 (July 2, 2003): 113–14.
  44. Cleophas, Ton J., and Aeilko H. Zwinderman. “Limitations of Randomized Clinical Trials. Proposed Alternative Designs.” Clinical Chemistry and Laboratory Medicine (CCLM) 38, no. 12 (December 4, 2000): 1217–23.
  45. LSHTM. “Cluster Randomised Trials.” Accessed September 14, 2020.
  46. Concato, John, Nirav Shah, and Ralph I. Horwitz. “Randomized, Controlled Trials, Observational Studies, and the Hierarchy of Research Designs.” New England Journal of Medicine 342, no. 25 (June 22, 2000): 1887–92.
  47. “Consort-Statement > CONSORT 2010 > Randomisation: Sequence Generation.” Accessed September 12, 2020.–consort-2010/86-randomisation-sequence-generation.
  48. Cook, Chad E., and Charles A. Thigpen. “Five Good Reasons to Be Disappointed with Randomized Trials.” Journal of Manual & Manipulative Therapy 27, no. 2 (March 15, 2019): 63–65.
  49. Craig, Peter, Paul Dieppe, Sally Macintyre, Susan Michie, Irwin Nazareth, Mark Petticrew, and Medical Research Council Guidance. “Developing and Evaluating Complex Interventions: The New Medical Research Council Guidance.” BMJ (Clinical Research Ed.) 337 (September 29, 2008): a1655.
  50. “Cureus | The Benefits and Limitations of Evidence-Based Practice in Osteopathy.” Accessed September 13, 2020.
  51. Dalziel, Margaret. “Why Are There (Almost) No Randomised Controlled Trial-Based Evaluations of Business Support Programmes?” Palgrave Communications 4, no. 1 (February 6, 2018): 1–9.
  52. Deaton, Angus, and Nancy Cartwright. “The Limitations of Randomised Controlled Trials.” VoxEU.Org (blog), November 9, 2016.
  53. ———. “Understanding and Misunderstanding Randomized Controlled Trials.” Social Science & Medicine, Randomized Controlled Trials and Evidence-based Policy: A Multidisciplinary Dialogue, 210 (August 1, 2018): 2–21.
  54. MedicineNet. “Definition of Randomized Controlled Trial.” Accessed September 14, 2020.
  55. Del Mar, Chris, and Tammy C. Hoffmann. “A Guide to Performing a Peer Review of Randomised Controlled Trials.” BMC Medicine 13, no. 1 (November 2, 2015): 248.
  56. Derksen, Jeroen W. G., Anne M. May, and Miriam Koopman. “The Era of Alternative Designs to Connect Randomized Clinical Trials and Real-World Data.” Nature Reviews Clinical Oncology 16, no. 9 (September 2019): 589–589.
  57. “Donald Berwick Discusses Health Care Improvement: Goals, Exemplary Organizations,and Being at a Turning Point – O’Reilly Radar.” Accessed September 11, 2020.
  58. Editor, Minitab Blog. “Repeated Measures Designs: Benefits, Challenges, and an ANOVA Example.” Accessed September 13, 2020.
  59. Eisman, John A., P. Geusens, and J. van den Bergh. “The Emperor’s New Clothes: What Randomized Controlled Trials Don’t Cover.” Journal of Bone and Mineral Research: The Official Journal of the American Society for Bone and Mineral Research 33, no. 8 (2018): 1394–96.
  60. Enkin, Murray. “(PDF) Using Anecdotal Information in Evidence-Based Health Care: Heresy or Necessity?” Accessed September 11, 2020.
  61. ResearchGate. “Estimating the Applicability of Wound Care Randomized Controlled Trials to General Wound-Care Populations by Estimating the Percentage of Individuals Excluded from a Typical Wound-Care Population in Such Trials | Request PDF.” Accessed September 14, 2020.
  62. Euser, Anne M., Carmine Zoccali, Kitty J. Jager, and Friedo W. Dekker. “Cohort Studies: Prospective versus Retrospective.” Nephron Clinical Practice 113, no. 3 (2009): c214–17.
  63. ResearchGate. “Evidence-Based Medicine in Wound Care | Request PDF.” Accessed September 13, 2020.
  64. Statistics How To. “Experimental Design.” Accessed September 13, 2020.
  65. “Experiments and Quasi-Experiments.” Accessed September 13, 2020.
  66. Expert, Industry. “Generalizability and Reproducibility of Scientific Literature and the Limits to Machine Learning.” Health IT Answers (blog), June 23, 2016.
  67. Ferreira, Juliana Carvalho, Cecilia Maria Patino, Juliana Carvalho Ferreira, and Cecilia Maria Patino. “Choosing Wisely between Randomized Controlled Trials and Observational Designs in Studies about Interventions.” Jornal Brasileiro de Pneumologia 42, no. 3 (June 2016): 165–165.
  68. Finley, Allysia. “Opinion | Medical Research’s Cross of ‘Gold’ Imperils Covid Treatments.” Wall Street Journal, September 8, 2020, sec. Opinion.
  69. Flanagan, Ryan F., and Olaf Dammann. “The Epistemological Weight of Randomized-Controlled Trials Depends on Their Results.” Perspectives in Biology and Medicine 61, no. 2 (2018): 157–73.
  70. Ford, Ian, and John Norrie. “Pragmatic Trials.” New England Journal of Medicine 375, no. 5 (August 4, 2016): 454–63.
  71. Foroughi, Siavash, Hui-li Wong, Lucy Gately, Margaret Lee, Koen Simons, Jeanne Tie, Antony Wilks Burgess, and Peter Gibbs. “Re-Inventing the Randomized Controlled Trial in Medical Oncology: The Registry-Based Trial.” Asia-Pacific Journal of Clinical Oncology 14, no. 6 (2018): 365–73.
  72. Freemantle, Nick, Melanie Calvert, John Wood, Joanne Eastaugh, and Carl Griffin. “Composite Outcomes in Randomized Trials: Greater Precision but with Greater Uncertainty?” JAMA 289, no. 19 (May 21, 2003): 2554–59.
  73. Frieden, Thomas R. “Evidence for Health Decision Making — Beyond Randomized, Controlled Trials.” New England Journal of Medicine 377, no. 5 (August 3, 2017): 465–75.
  74. “Frontiers | To Mix or Not To Mix? A Meta-Method Approach to Rethinking Evaluation Practices for Improved Effectiveness and Efficiency of Psychological Therapies Illustrated With the Application of Perceptual Control Theory | Psychology.” Accessed September 13, 2020.
  75. HCPLive. “Fundamentals of Clinical Research: Cohort Studies and Randomized Controlled Trials.” Accessed September 13, 2020.
  76. Gaille, Louise. “14 Advantages and Disadvantages of a Randomized Controlled Trial.” Accessed September 13, 2020.
  77. Gal, Roxanne, Evelyn M. Monninkhof, Carla H. van Gils, Rolf H. H. Groenwold, Desirée H. J. G. van den Bongard, Petra H. M. Peeters, Helena M. Verkooijen, and Anne M. May. “The Trials within Cohorts Design Faced Methodological Advantages and Disadvantages in the Exercise Oncology Setting.” Journal of Clinical Epidemiology 113 (September 1, 2019): 137–46.
  78. Gelman, Andrew. “Benefits and Limitations of Randomized Controlled Trials,” n.d., 3.
  79. Gerstein, Hertzel C., John McMurray, and Rury R. Holman. “Real-World Studies No Substitute for RCTs in Establishing Efficacy.” The Lancet 393, no. 10168 (January 19, 2019): 210–11.
  80. ———. “The Importance of Randomised vs Non-Randomised Trials – Authors’ Reply.” The Lancet 394, no. 10199 (August 24, 2019): 635.
  81. Government of Canada, Canadian Institutes of Health Research. “RCT Evaluation Criteria and Headings – CIHR,” January 6, 2009.
  82. Graham, Pamela Louise, Riccardo Russo, and Margaret Anne Defeyter. “The Advantages and Disadvantages of Breakfast Clubs According to Parents, Children, and School Staff in the North East of England, UK.” Frontiers in Public Health 3 (2015).
  83. Group, British Medical Journal Publishing. “Inappropriate Use of Randomised Trials to Evaluate Complex Phenomena: Case Study of Vaginal Breech Delivery.” BMJ 329, no. 7479 (December 9, 2004): 1385.
  84. Diet Doctor. “Guide to Observational vs. Experimental Studies.” Accessed September 13, 2020.
  85. “Guide to Randomized Clinical Trials – IFFGD.” Accessed September 13, 2020.
  86. “Guide to Randomized Clinical Trials – IFFGD.” Accessed September 13, 2020.
  87. Guyatt, Gordon H., Andrew D. Oxman, Gunn Vist, Regina Kunz, Jan Brozek, Pablo Alonso-Coello, Victor Montori, et al. “GRADE Guidelines: 4. Rating the Quality of Evidence–Study Limitations (Risk of Bias).” Journal of Clinical Epidemiology 64, no. 4 (April 2011): 407–15.
  88. Hammoudeh, Samer, Wessam Gadelhaq, and Ibrahim Janahi. “Prospective Cohort Studies in Medical Research.” Cohort Studies in Health Sciences, November 5, 2018.
  89. Herrera-Perez, Diana, Alyson Haslam, Tyler Crain, Jennifer Gill, Catherine Livingston, Victoria Kaestner, Michael Hayes, Dan Morgan, Adam S Cifu, and Vinay Prasad. “A Comprehensive Review of Randomized Clinical Trials in Three Medical Journals Reveals 396 Medical Reversals.” Edited by Eduardo Franco and Adam Elshaug. ELife 8 (June 11, 2019): e45183.
  90. Hidefumi, Yokoo. “Are There Ethical Issues with Randomized Controlled Trials by Economists? Evidence from Two Online Surveys in Japan (Japanese).” Discussion Papers (Japanese). Discussion Papers (Japanese). Research Institute of Economy, Trade and Industry (RIETI), January 2019.
  91. Hj, Möller. “Effectiveness Studies: Advantages and Disadvantages.” Dialogues in Clinical Neuroscience 13, no. 2 (January 1, 2011): 199–207.
  92. Hollon, Steven D., and Bruce E. Wampold. “Are Randomized Controlled Trials Relevant to Clinical Practice?” Canadian Journal of Psychiatry. Revue Canadienne De Psychiatrie 54, no. 9 (September 2009): 637–43.
  93. Horn, Susan D., Gerben DeJong, David K. Ryser, Peter J. Veazie, and Jeffrey Teraoka. “Another Look at Observational Studies in Rehabilitation Research: Going Beyond the Holy Grail of the Randomized Controlled Trial.” Archives of Physical Medicine and Rehabilitation 86, no. 12 (December 1, 2005): 8–15.
  94. Hui, David, Donna S. Zhukovsky, and Eduardo Bruera. “Which Treatment Is Better? Ascertaining Patient Preferences with Crossover Randomized Controlled Trials.” Journal of Pain and Symptom Management 49, no. 3 (March 2015): 625–31.
  95. The Scientist Magazine®. “Infographic: N-of-1 Studies Tackle Limitations of Randomized Controlled Trials.” Accessed September 12, 2020.–n-of-1-studies-tackle-limitations-of-randomized-controlled-trials-66138.
  96. Innocenti, UNICEF Office of Research-. “Randomized Controlled Trials (RCTs): Methodological Briefs – Impact Evaluation No. 7.” UNICEF-IRC. Accessed September 13, 2020.
  97. “Intervention Studies.” Accessed September 13, 2020.
  98. Jager, K. J., C. Zoccali, A. MacLeod, and F. W. Dekker. “Confounding: What It Is and How to Deal with It.” Kidney International 73, no. 3 (February 1, 2008): 256–60.
  99. Johansson, Eva, Fredrik Hammarskjöld, Dag Lundberg, and Marianne Heibert Arnlind. “Advantages and Disadvantages of Peripherally Inserted Central Venous Catheters (PICC) Compared to Other Central Venous Lines: A Systematic Review of the Literature.” Acta Oncologica (Stockholm, Sweden) 52, no. 5 (June 2013): 886–92.
  100. Juszczak, Edmund, Douglas G. Altman, Sally Hopewell, and Kenneth Schulz. “Reporting of Multi-Arm Parallel-Group Randomized Trials: Extension of the CONSORT 2010 Statement.” JAMA 321, no. 16 (April 23, 2019): 1610–20.
  101. Kahan, Brennan C., Sunita Rehal, and Suzie Cro. “Risk of Selection Bias in Randomised Trials.” Trials 16 (September 10, 2015).
  102. Kenneth, Stanley. “Design of Randomized Controlled Trials | Circulation.” Accessed September 11, 2020.
  103. Kinoshita, Yoshikazu, Norihisa Ishimura, and Shunji Ishihara. “Advantages and Disadvantages of Long-Term Proton Pump Inhibitor Use.” Journal of Neurogastroenterology and Motility 24, no. 2 (April 30, 2018): 182–96.
  104. Korn, Edward L., and Boris Freidlin. “Adaptive Clinical Trials: Advantages and Disadvantages of Various Adaptive Design Elements.” Journal of the National Cancer Institute 109, no. 6 (01 2017).
  105. Krauss, Alexander. “Why All Randomised Controlled Trials Produce Biased Results.” Annals of Medicine 50, no. 4 (May 19, 2018): 312–22.
  106. Krishnan, Nikhil. “Random Uncontrolled Trials/Tweets.” Accessed September 13, 2020.
  107. Krogh, Helle B., Ole Jakob Storebø, Erlend Faltinsen, Adnan Todorovac, Erica Ydedahl-Jensen, Frederik Løgstrup Magnusson, Mathilde Holmskov, Trine Gerner, Christian Gluud, and Erik Simonsen. “Methodological Advantages and Disadvantages of Parallel and Crossover Randomised Clinical Trials on Methylphenidate for Attention Deficit Hyperactivity Disorder: A Systematic Review and Meta-Analyses.” BMJ Open 9, no. 3 (March 1, 2019): e026478.
  108. Kumar, Navin, Jessica Ainooson, Ameera Billings, Grace Chen, Lauren Cueto, Kamila Janmohamed, Jeannette Jiang, Raymond Niaura, and Amy Zhang. “The Scope of Tobacco Cessation Randomized Controlled Trials in Low- to Middle-Income Countries: Protocol for a Scoping Review.” Systematic Reviews 9, no. 1 (April 21, 2020): 86.
  109. StuDocu. “L14 CNCSP 102 – Lecture Notes 14 – UC Santa Barbara.” Accessed September 13, 2020.
  110. Lefkowitz, W., and T. C. Jefferson. “Medicine at the Limits of Evidence: The Fundamental Limitation of the Randomized Clinical Trial and the End of Equipoise.” Journal of Perinatology 34, no. 4 (April 2014): 249–51.
  111. Life in the Fast Lane • LITFL • Medical Blog. “Life in the Fast Lane • LITFL • Medical Blog • Emergency Medicine and Critical Care Medical Education Blog.” Accessed September 12, 2020.
  112. Lilienfeld, Scott O., Dean McKay, and Steven D. Hollon. “Why Randomised Controlled Trials of Psychological Treatments Are Still Essential.” The Lancet Psychiatry 5, no. 7 (July 1, 2018): 536–38.
  113. The Incidental Economist. “Limitations of Randomized Trials,” May 19, 2010.
  114. Lin, Jaung-Geng, Chao-Hsun Chen, Yu-Che Huang, and Yi-Hung Chen. “How to Design the Control Group in Randomized Controlled Trials of Acupuncture?” Review Article. Evidence-Based Complementary and Alternative Medicine. Hindawi, July 5, 2012.
  115. Mariani, Alessandro Wasum, Paulo Manuel Pego-Fernandes, Alessandro Wasum Mariani, and Paulo Manuel Pego-Fernandes. “Observational Studies: Why Are They so Important?” Sao Paulo Medical Journal 132, no. 1 (2014): 01–02.
  116. “Medical Acupuncture — A Review | 2002-07-08 | AHC Media: Continuing Medical Education Publishing.” Accessed September 13, 2020.
  117. Tablet Magazine. “Medicine’s Fundamentalists,” August 14, 2020. /sections/science/articles/randomized-control-tests-doidge.
  118. Tablet Magazine. “Medicine’s Fundamentalists,” August 14, 2020. /sections/science/articles/randomized-control-tests-doidge.
  119. Miranda, J. Jaime, and M. Justin Zaman. “Exporting ‘Failure’: Why Research from Rich Countries May Not Benefit the Developing World.” Revista de Saúde Pública 44, no. 1 (February 2010): 185–89.
  120. Mora, Mariela Acuña, Markus Saarijärvi, Philip Moons, Carina Sparud-Lundin, Ewa-Lena Bratt, and Eva Goossens. “The Scope of Research on Transfer and Transition in Young Persons With Chronic Conditions.” Journal of Adolescent Health 65, no. 5 (November 1, 2019): 581–89.
  121. Moss, Arthur J., Charles W. Francis, and Daniel Ryan. “Collaborative Clinical Trials.” New England Journal of Medicine 364, no. 9 (March 3, 2011): 789–91.
  122. Mulder, Roger, Ajeet B. Singh, Amber Hamilton, Pritha Das, Tim Outhred, Grace Morris, Darryl Bassett, et al. “The Limitations of Using Randomised Controlled Trials as a Basis for Developing Treatment Guidelines.” Evidence-Based Mental Health 21, no. 1 (February 1, 2018): 4–6.
  123. Murphy, Chris B. “Pros and Cons of Stratified Random Sampling.” Investopedia. Accessed September 13, 2020.
  124. “News Glossary – Behind the Headlines – NHS Choices,” August 3, 2017.
  125. NFER. “A Guide to Running Randomised Controlled Trials for Educational Researchers.” NFER. Accessed September 13, 2020.
  126. “Non-Randomised Controlled Study (NRS) Designs.” Accessed September 13, 2020. /non-randomised-controlled-study-nrs-designs.
  127. “Observational vs. Experimental Studies.” Accessed September 13, 2020.
  128. “Observational vs. Experimental Studies.” Accessed September 13, 2020.
  129. Okifuji, Akiko, Jeff Gao, Christina Bokat, and Bradford D Hare. “Management of Fibromyalgia Syndrome in 2016.” Pain Management 6, no. 4 (June 16, 2016): 383–400.
  130. Osimani, Barbara. “Until RCT Proven? On the Asymmetry of Evidence Requirements for Risk Assessment.” Journal of Evaluation in Clinical Practice 19, no. 3 (2013): 454–62.
  131. Pallmann, Philip, Alun W. Bedding, Babak Choodari-Oskooei, Munyaradzi Dimairo, Laura Flight, Lisa V. Hampson, Jane Holmes, et al. “Adaptive Designs in Clinical Trials: Why Use Them, and How to Run and Report Them.” BMC Medicine 16, no. 1 (February 28, 2018): 29.
  132. Pandis, Nikolaos. “Randomization. Part 2: Minimization.” American Journal of Orthodontics and Dentofacial Orthopedics 140, no. 6 (December 2011): 902–4.
  133. Parkway, Nuventra Pharma Sciences2525 Meridian, and Suite 200 Durham. “What Is an Adaptive Clinical Trial Design? | Benefits & Pitfalls.” PK / PD and Clinical Pharmacology Consultants, February 19, 2020.
  134. PhD, Maher M. El-Masri, RN. “Terminology 101: Blinding in RCTs.” Accessed September 13, 2020.
  135. Pincus, Theodore. “Limitations of Traditional Randomized Controlled Clinical Trials in Rheumatology.” In Understanding Evidence-Based Rheumatology: A Guide to Interpreting Criteria, Drugs, Trials, Registries, and Ethics, edited by Hasan Yazici, Yusuf Yazici, and Emmanuel Lesaffre, 179–207. Cham: Springer International Publishing, 2014.
  136. Porzsolt, Franz, and Hartmut Kliemt. “Ethische und empirische Grenzen randomisierter kontrollierter Studien.” Medizinische Klinik 103, no. 12 (December 2008): 836–42.
  137. “Problems with Randomized Controlled Trials (or Any Bounded Statistical Analysis) and Thinking More Seriously about Story Time : Statistics.” Accessed September 13, 2020.
  138. Pancreatic Cancer UK. “Pros & Cons of Clinical Trials.” Accessed September 13, 2020.
  139. Life in the Fast Lane • LITFL • Medical Blog. “Randomised Control Trials • LITFL • CCC Research,” January 4, 2019.
  140. Life in the Fast Lane • LITFL • Medical Blog. “Randomised Control Trials • LITFL • CCC Research,” January 4, 2019.
  141. “Randomised Controlled Trial | Better Evaluation.” Accessed September 13, 2020.
  142. GOV.UK. “Randomised Controlled Trial: Comparative Studies.” Accessed September 13, 2020.
  143. “Randomised Controlled Trials.” Accessed September 13, 2020.
  144. Cancer Research UK. “Randomised Trials,” October 21, 2014.
  145. “Randomised Trials | CEBD.” Accessed September 13, 2020.
  146. Friends of Cancer Research. “Randomized and Single-Arm Trials,” August 21, 2013.
  147. “Randomized Controlled Trial – Wikipedia.” Accessed September 13, 2020.
  148. “Randomized Controlled Trial (RCT): Biostatistics Review.” Accessed September 13, 2020.
  149. “Randomized Controlled Trials: Overview, Benefits, and Limitations,” December 4, 2018.
  150. “Randomized Controlled Trials: Questions, Answers and Musings, 2nd Edition | Wiley.” Accessed September 4, 2020.
  151. BetterEvaluation. “Randomized Controlled Trials (RCTs),” November 26, 2014.
  152. “Randomized Trials vs Meta-Analyses: Which Is the Better Bet? – The ASCO Post.” Accessed September 13, 2020.
  153. Ratain, Jill S., and Marc C. Hochberg. “Clinical Trials.” Arthritis & Rheumatism 33, no. 1 (1990): 131–39.
  154. Razif Shahril. “6. Randomised Controlled Trial.” Health & Medicine, 16:01:18 UTC.
  155. LARS P. SYLL. “RCTs — Pros and Cons,” August 14, 2014.
  156. Read “Integrating Clinical Research into Epidemic Response: The Ebola Experience” at NAP.Edu. Accessed September 14, 2020.
  157. “Research and Evidence-Based Medicine | Murtagh’s General Practice, 6e | Murtagh Collection | McGraw-Hill Medical.” Accessed September 13, 2020.
  158. Life in the Fast Lane • LITFL • Medical Blog. “Retrospective Studies and Chart Reviews • LITFL • CCC Research,” January 9, 2019.
  159. “RIETI – Are There Ethical Issues with Randomized Controlled Trials by Economists? Evidence from Two Online Surveys in Japan.” Accessed September 12, 2020.
  160. Rosen, Laura, Orly Manor, Dan Engelhard, and David Zucker. “In Defense of the Randomized Controlled Trial for Health Promotion Research.” American Journal of Public Health 96, no. 7 (July 2006): 1181–86.
  161. Roubaud, François, and Isabelle Guérin. “2019 Nobel Prize in Economics: The Limits of the Clinical Trial Method.” The Conversation. Accessed September 12, 2020.
  162. Rudd, Peter. “Randomised Controlled Trials (RCTs) in Practice: An Examination of the Advantages and the Potential Pitfalls of Using RCTs in Education.” Accessed September 12, 2020.
  163. Salkind, Neil. Encyclopedia of Research Design. 2455 Teller Road, Thousand Oaks California 91320 United States: SAGE Publications, Inc., 2010.
  164. Sanson-Fisher, Robert William, Billie Bonevski, Lawrence W. Green, and Cate D’Este. “Limitations of the Randomized Controlled Trial in Evaluating Population-Based Health Interventions.” American Journal of Preventive Medicine 33, no. 2 (August 1, 2007): 155–61.
  165. Saturni, S., F. Bellini, F. Braido, P. Paggiaro, A. Sanduzzi, N. Scichilone, P. A. Santus, L. Morandi, and A. Papi. “Randomized Controlled Trials and Real Life Studies. Approaches and Methodologies: A Clinical Point of View.” Pulmonary Pharmacology & Therapeutics 27, no. 2 (April 2014): 129–38.
  166. Shean, Glenn. “Limitations of Randomized Control Designs in Psychotherapy Research.” Review Article. Advances in Psychiatry. Hindawi, November 6, 2014.
  167. Sibinga, Erica M. S., and Jacky M. Jennings. “Strengths and Limitations of Randomized, Controlled Trials.” Pediatrics in Review 31, no. 7 (July 2010): 296–97.
  168. “Single or Multicentre Trials.” Accessed September 13, 2020.
  169. “Single-Blind Study.” In Encyclopedia of Research Design. 2455 Teller Road, Thousand Oaks California 91320 United States: SAGE Publications, Inc., 2010.
  170. sitecore\ “Dissecting the Literature: The Importance of Critical Appraisal.” Royal College of Surgeons. Accessed September 14, 2020.
  171. Speich, Benjamin, Nadine Schur, Dmitry Gryaznov, Belinda von Niederhäusern, Lars G. Hemkens, Stefan Schandelmaier, Alain Amstutz, et al. “Resource Use, Costs, and Approval Times for Planning and Preparing a Randomized Clinical Trial before and after the Implementation of the New Swiss Human Research Legislation.” PLOS ONE 14, no. 1 (January 11, 2019): e0210669.
  172. Spieth, Peter Markus, Anne Sophie Kubasch, Ana Isabel Penzlin, Ben Min-Woo Illigens, Kristian Barlinn, and Timo Siepmann. “Randomized Controlled Trials – a Matter of Design.” Neuropsychiatric Disease and Treatment 12 (June 10, 2016): 1341–49.
  173. Stephenson, Judith, and John Imrie. “Why Do We Need Randomised Controlled Trials to Assess Behavioural Interventions?” BMJ : British Medical Journal 316, no. 7131 (February 14, 1998): 611–13.
  174. Stolberg, Harald O., Geoffrey Norman, and Isabelle Trop. “Randomized Controlled Trials.” American Journal of Roentgenology 183, no. 6 (December 1, 2004): 1539–44.
  175. “Study Designs — Centre for Evidence-Based Medicine, University of Oxford.” Web Page. Accessed September 13, 2020.
  176. ResearchGate. “Table 5 Some Advantages and Disadvantages of Random- Ized And…” Accessed September 13, 2020.
  177. Tang, D. H., T. L. Warholak, L. E. Hines, J. Hurwitz, M. Brown, A. M. Taylor, D. Brixner, and D. C. Malone. “Evaluation of Pharmacy and Therapeutic (P&T) Committee Member Knowledge, Attitudes and Ability Regarding the Use of Comparative Effectiveness Research (CER) in Health Care Decision-Making.” Research in Social and Administrative Pharmacy 10, no. 5 (September 1, 2014): 768–80.
  178. Tashkin, Donald P., Alpesh N. Amin, and Edward M. Kerwin. “<p>Comparing Randomized Controlled Trials and Real-World Studies in Chronic Obstructive Pulmonary Disease Pharmacotherapy</P>.” International Journal of Chronic Obstructive Pulmonary Disease. Dove Press, June 2, 2020.
  179. Clinical Sciences. “The Advantages and Disadvantages of Observational and Randomised Controlled Trials in Evaluating New Interventions in Medicine.,” June 9, 2011.
  180. Clinical Sciences. “The Advantages and Disadvantages of Observational and Randomised Controlled Trials in Evaluating New Interventions in Medicine.,” June 9, 2011.
  181. The Disadvantages of Randomised Clinical Trials, 2017.
  182. “The Limitations of Randomized Controlled Trials | ASSOCIATION OF INTEGRATIVE ONCOLOGY AND CHINESE MEDICINE(AIOCM).” Accessed September 12, 2020.
  183. “The Pitfalls of Randomized Controlled Trials.” Accessed September 13, 2020.
  184. “The Problems with Randomised Controlled Trials | VOX, CEPR Policy Portal.” Accessed September 12, 2020.
  185. “The Review Of Randomised Control Trials.” Accessed September 13, 2020.
  186. Torgerson, David J., and Carole J. Torgerson. “Avoiding Bias in Randomised Controlled Trials in Educational Research.” British Journal of Educational Studies 51, no. 1 (2003): 36–45.
  187. Turner, Murray. “UC Library Guides: Evidence-Based Practice in Health: Hierarchy of Evidence.” Accessed September 13, 2020.
  188. Pharmaceutical Training – Astra Nova. “Understanding Randomized Controlled Trials: Why Are They Important?,” June 16, 2015.
  189. “US Payers: Comparative Effectiveness Research (CER) and Formulary Decision-Making.” Accessed September 12, 2020.
  190. “Using Multiple Types of Studies in Systematic Reviews of Health Care Interventions – A Systematic Review.” Accessed September 13, 2020.
  191. Vincent, Jean-Louis. “The Coming Era of Precision Medicine for Intensive Care.” Critical Care 21, no. Suppl 3 (December 28, 2017).
  192. “Vitamin D and Pregnancy – When Headlines Mislead… – GrassrootsHealth.” Accessed September 13, 2020.
  193. EN Testing Treatments interactive. “What Are Randomised Controlled Trials and Why Are They Important?,” February 4, 2014.
  194. “What Are the Advantages and Disadvantages of Emergent Cricothyrotomy?” Accessed September 13, 2020.
  195. “Why Randomised Controlled Trials of Psychological Treatments Are Still Essential – The Lancet Psychiatry.” Accessed September 13, 2020.
  196. STAT. “Why the ‘gold Standard’ of Medical Research Is No Longer Enough,” August 2, 2017.
  197. STAT. “Why the ‘gold Standard’ of Medical Research Is No Longer Enough,” August 2, 2017.
  198. “Willful Ignorance: The Mismeasure of Uncertainty | Wiley.” Accessed September 4, 2020.
  199. Wojcieszek, Aleena M., Alexander EP Heazell, Philippa Middleton, David Ellwood, Robert M. Silver, and Vicki Flenady. “Research Priorities and Potential Methodologies to Inform Care in Subsequent Pregnancies Following Stillbirth: A Web-Based Survey of Healthcare Professionals, Researchers and Advocates.” BMJ Open 9, no. 6 (June 1, 2019): e028735.
  200. Wu, Jianqing, and Ping Zha. “Randomized Clinical Trial Is Biased and Invalid In Studying Chronic Diseases, Compared with Multiple Factors Optimization Trial.” SSRN Electronic Journal, 2019.
  201. Zahiri Harsini, Azita, Fazlollah Ghofranipour, Hormoz Sanaeinasab, and Farkhondeh Amin Shokravi. “A Randomised Controlled Trial of an Educational Intervention to Promote Safe Behaviours in Petrochemical Workers: A Study Protocol.” BMC Public Health 19, no. 1 (June 18, 2019): 776.
  202. Zeilstra, Dennis, Jessica A. Younes, Robert J. Brummer, and Michiel Kleerebezem. “Perspective: Fundamental Limitations of the Randomized Controlled Trial Method in Nutritional Research: The Example of Probiotics.” Advances in Nutrition 9, no. 5 (September 1, 2018): 561–71.



Bibliography on Wearing Masks for Infection Protection

  1. Psychology Today. “5 More Ways That COVID-19 Is Not Like the Flu.” Accessed September 10, 2020.
  2. Bored Panda. “30 People Shame Those Who Refuse To Wear A Mask Due To Their Own Stupid Reasons.” Accessed September 10, 2020.
  3. Aj, Sant, and McMichael A. “Revealing the Role of CD4(+) T Cells in Viral Immunity.” The Journal of Experimental Medicine 209, no. 8 (July 1, 2012): 1391–95.
  4. Anfinrud, Philip, Valentyn Stadnytskyi, Christina E. Bax, and Adriaan Bax. “Visualizing Speech-Generated Oral Fluid Droplets with Laser Light Scattering.” New England Journal of Medicine 382, no. 21 (May 21, 2020): 2061–63.
  5. “Are Face Masks Effective? The Evidence. – Swiss Policy Research.” Accessed September 9, 2020.
  6. ResearchGate. “Assessment of Fabric Masks as Alternatives to Standard Surgical Masks in Terms of Particle Filtration Efficiency | Request PDF.” Accessed September 10, 2020.
  7. “Association of Country-Wide Coronavirus Mortality with Demographics, Testing, Lockdowns, and Public Wearing of Masks. Update August 4, 2020. | MedRxiv.” Accessed September 9, 2020.
  8. Aug 06, 2020. “OSHA Addresses Inaccurate Claims That Face Coverings Cause Wearer Harm -.” Occupational Health & Safety. Accessed September 10, 2020.
  9. Author, Alternate. “Blaylock: Face Masks Pose Serious Risks To The Healthy.” Technocracy News. Accessed September 9, 2020.
  10. Av, Mueller, Eden Mj, Oakes Jj, Bellini C, and Fernandez La. “Quantitative Method for Comparative Assessment of Particle Filtration Efficiency of Fabric Masks as Alternatives to Standard Surgical Masks for PPE,” April 22, 2020.
  11. B, Chandrasekaran, and Fernandes S. “‘Exercise with Facemask; Are We Handling a Devil’s Sword?’ – A Physiological Hypothesis.” Medical hypotheses. Med Hypotheses, June 22, 2020.
  12. Bae, Seongman, Min-Chul Kim, Ji Yeun Kim, Hye-Hee Cha, Joon Seo Lim, Jiwon Jung, Min-Jae Kim, et al. “Effectiveness of Surgical and Cotton Masks in Blocking SARS–CoV-2: A Controlled Comparison in 4 Patients.” Annals of Internal Medicine 173, no. 1 (April 6, 2020): W22–23.
  13. Beder, A., U. Büyükkoçak, H. Sabuncuoğlu, Z. A. Keskil, and S. Keskil. “Preliminary Report on Surgical Mask Induced Deoxygenation during Major Surgery.” Neurocirugia (Asturias, Spain) 19, no. 2 (April 2008): 121–26.
  14. Psychology Today. “‘Beginner’s Mind’ Just Might Save Lives.” Accessed September 10, 2020.
  15. News Break. “Both Big and Tiny Coronavirus Droplets Can Travel Far through Air.” Accessed September 10, 2020.
  16. Bourouiba, Lydia. “Turbulent Gas Clouds and Respiratory Pathogen Emissions: Potential Implications for Reducing Transmission of COVID-19.” JAMA 323, no. 18 (May 12, 2020): 1837–38.
  17. Brooks, John T., Jay C. Butler, and Robert R. Redfield. “Universal Masking to Prevent SARS-CoV-2 Transmission-The Time Is Now.” JAMA, July 14, 2020.
  18. Brosseau, Lisa M., ScD, Margaret Sietsema, PhD | Apr 01, and 2020. “COMMENTARY: Masks-for-All for COVID-19 Not Based on Sound Data.” CIDRAP. Accessed September 8, 2020.
  19. Mayo Clinic. “Can Face Masks Protect against the Coronavirus?” Accessed September 9, 2020.
  20. CDC. “Coronavirus Disease 2019 (COVID-19).” Centers for Disease Control and Prevention, February 11, 2020.
  21. Chaudhry, Rabail, George Dranitsaris, Talha Mubashir, Justyna Bartoszko, and Sheila Riazi. “A Country Level Analysis Measuring the Impact of Government Actions, Country Preparedness and Socioeconomic Factors on COVID-19 Mortality and Related Health Outcomes.” EClinicalMedicine 25 (August 1, 2020).
  22. Chu, Derek K., Elie A. Akl, Stephanie Duda, Karla Solo, Sally Yaacoub, Holger J. Schünemann, Derek K. Chu, et al. “Physical Distancing, Face Masks, and Eye Protection to Prevent Person-to-Person Transmission of SARS-CoV-2 and COVID-19: A Systematic Review and Meta-Analysis.” The Lancet 395, no. 10242 (June 27, 2020): 1973–87.
  23. Chughtai, Abrar A., Holly Seale, and C. Raina Macintyre. “Early Release – Effectiveness of Cloth Masks for Protection Against Severe Acute Respiratory Syndrome Coronavirus 2 – Volume 26, Number 10—October 2020 – Emerging Infectious Diseases Journal – CDC.” Accessed September 10, 2020.
  24. Clase, Catherine M., Edouard L. Fu, Aurneen Ashur, Rupert CL. Beale, Imogen A. Clase, Myrna B. Dolovich, Meg J. Jardine, et al. “Forgotten Technology in the COVID-19 Pandemic. Filtration Properties of Cloth and Cloth Masks: A Narrative Review.” Mayo Clinic Proceedings, July 31, 2020.
  25. Clase, Catherine M., Edouard L. Fu, Meera Joseph, Rupert C.L. Beale, Myrna B. Dolovich, Meg Jardine, Johannes F.E. Mann, Roberto Pecoits-Filho, Wolfgang C. Winkelmayer, and Juan J. Carrero. “Cloth Masks May Prevent Transmission of COVID-19: An Evidence-Based, Risk-Based Approach.” Annals of Internal Medicine, May 22, 2020.
  26. “COVID-19: Considerations for Wearing Masks | CDC.” Accessed September 10, 2020.
  27. “COVID19 PCR Tests Are Scientifically Meaningless – Bulgarian Pathology Association.” Accessed September 10, 2020.
  28. “COVID-19–Related Perceptions, Context and Attitudes of Adults with Chronic Conditions: Results from a Cross-Sectional Survey Nested in the ComPaRe e-Cohort.” Accessed September 10, 2020.
  29. “Dear Humans: Face Masks Don’t Work; the Study-Review Was Published by Your Very Own CDC « Jon Rappoport’s Blog.” Accessed September 10, 2020.
  30. News Break. “Does Personality Predict Willingness to Wear a Mask?” Accessed September 10, 2020.
  31. “Does Wearing a Mask Cause Diagnostic Tests to Read False-Positive for COVID? « Jon Rappoport’s Blog.” Accessed September 10, 2020.
  32. “Does Wearing a Mask Pose Any Health Risks?” Accessed September 10, 2020.
  33. Healthline. “Does Wearing a Mask Prevent the Flu?,” July 29, 2020.
  34. “Does Wearing a Mask Protect Me? Some Evidence Says Yes – The New York Times.” Accessed September 10, 2020.
  35. News Break. “Dutch Dr. Fauci Thinks Masks Won’t Work. Here’s Why.” Accessed September 10, 2020.
  36. EDT, Basit Mahmood On 7/23/20 at 1:29 PM. “Doctor Runs 22 Miles Wearing Face Mask to Show It Doesn’t Cut Oxygen Levels.” Newsweek, July 23, 2020.
  37. Esposito, Susanna, Nicola Principi, Chi Chi Leung, and Giovanni Battista Migliori. “Universal Use of Face Masks for Success against COVID-19: Evidence and Implications for Prevention Policies.” European Respiratory Journal 55, no. 6 (June 1, 2020).
  38. “Face Masks Considerably Reduce COVID-19 Cases in Germany: A Synthetic Control Method Approach.” Accessed September 10, 2020.
  39. MSN. “Face Masks Protect You More From COVID Than You Thought, Doctors Say.” Accessed September 10, 2020.
  40. “Facemasks and Similar Barriers to Prevent Respiratory Illness Such as COVID-19: A Rapid Systematic Review | MedRxiv.” Accessed September 10, 2020.
  41. “Formal Request for the Retraction of Zhang et al., 2020 | Meta-Research Innovation Center at Stanford.” Accessed September 10, 2020.
  42. Frankel, Todd C. “The Outbreak That Didn’t Happen: Masks Credited with Preventing Coronavirus Spread inside Missouri Hair Salon.” Washington Post. Accessed September 10, 2020.
  43. G, Monica, and hi. “Mask Wearers Are ‘Dramatically Less Likely’ to Get a Severe Case of Covid-19.” Inverse. Accessed September 9, 2020.
  44. Gandhi, Monica. “Can People Spread the Coronavirus If They Don’t Have Symptoms? 5 Questions Answered about Asymptomatic COVID-19.” The Conversation. Accessed September 9, 2020.
  45. Gandhi, Monica, Chris Beyrer, and Eric Goosby. “Masks Do More Than Protect Others During COVID-19: Reducing the Inoculum of SARS-CoV-2 to Protect the Wearer.” Journal of General Internal Medicine, July 31, 2020.
  46. Gandhi, Monica, and Diane Havlir. “The Time for Universal Masking of the Public for Coronavirus Disease 2019 Is Now.” Open Forum Infectious Diseases 7, no. 4 (April 2020): ofaa131.
  47. Ghesquierre, Wayne. “Comment: Wear a Mask to Protect Yourself and Others. You Will Not Be Harmed.” Times Colonist. Accessed September 10, 2020.
  48. Grinshpun, Sergey A., Hiroki Haruta, Robert M. Eninger, Tiina Reponen, Roy T. McKay, and Shu-An Lee. “Performance of an N95 Filtering Facepiece Particulate Respirator and a Surgical Mask During Human Breathing: Two Pathways for Particle Penetration.” Journal of Occupational and Environmental Hygiene 6, no. 10 (September 9, 2009): 593–603.
  49. Hamzelou, Jessica. “Do Face Masks Work against the Coronavirus and Should You Wear One?” New Scientist. Accessed September 10, 2020.
  50. Howard, Jeremy, Austin Huang, Zhiyuan Li, Zeynep Tufekci, Vladimir Zdimal, Helene-Mari van der Westhuizen, Arne von Delft, et al. “Face Masks Against COVID-19: An Evidence Review,” April 12, 2020.
  51. Newsweek. “‘I Ran 22 Miles In A Mask To Show They Are Safe,’” July 28, 2020.
  52. Ing, Alvin J., Christine Cocks, and Jeffery Peter Green. “COVID-19: In the Footsteps of Ernest Shackleton.” Thorax 75, no. 8 (August 1, 2020): 693–94.
  53. The Daily Wire. “Is Herd Immunity An Effective Strategy? Here’s What The Latest Studies Found.” Accessed September 10, 2020.
  54. Jacobs, Joshua L., Sachiko Ohde, Osamu Takahashi, Yasuharu Tokuda, Fumio Omata, and Tsuguya Fukui. “Use of Surgical Face Masks to Reduce the Incidence of the Common Cold among Health Care Workers in Japan: A Randomized Controlled Trial.” American Journal of Infection Control 37, no. 5 (June 2009): 417–19.
  55. Jefferson, Tom, Mark Jones, Lubna A. Al Ansari, Ghada Bawazeer, Elaine Beller, Justin Clark, John Conly, et al. “Physical Interventions to Interrupt or Reduce the Spread of Respiratory Viruses. Part 1 – Face Masks, Eye Protection and Person Distancing: Systematic Review and Meta-Analysis.” MedRxiv, April 7, 2020, 2020.03.30.20047217.
  56. July 9, Charlie Duerr, and 2020. “The One Face Mask Hack You’re Not Doing But Should Be.” Best Life, July 9, 2020.
  57. Jun 24, Stephanie Soucheray | News Reporter | CIDRAP News |, and 2020. “Controversy on COVID-19 Mask Study Spotlights Messiness of Science during a Pandemic.” CIDRAP. Accessed September 10, 2020.
  58. June 15, Colby Hall, and 2020. “172 Studies Agree You Need to Do This to Combat Coronavirus.” Best Life, June 15, 2020.
  59. “Keep Britain Free.” Accessed September 10, 2020.
  60. Klompas, Michael, Charles A. Morris, Julia Sinclair, Madelyn Pearson, and Erica S. Shenoy. “Universal Masking in Hospitals in the Covid-19 Era.” New England Journal of Medicine 382, no. 21 (May 21, 2020): e63.
  61., <img src=’//sgec stanford edu/content/dam/sm-news/images/2015/10/conger-krista-90 jpg img 620 high png’ alt=’Krista Conger’> By Krista Conger Krista Conger is a science writer in the Office of Communications Email her at. “5 Questions: Stanford Scientists on COVID-19 Mask Guidelines.” News Center. Accessed September 10, 2020.
  62. kyle8425. “On Masks: Notes for Rebuttal.” Another Logical Take (blog), July 24, 2020.
  63. ———. “Resolved: Public Mask Mandates Assist in Curbing the Spread of Covid-19.” Another Logical Take (blog), July 24, 2020.
  64. “Lack of COVID-19 Transmission on an International Flight | CMAJ.” Accessed September 10, 2020.
  65. “Letter to the Editor: Look at the Range of Science on Face Masks | TribLIVE.Com.” Accessed September 10, 2020.
  66. Leung, Nancy H. L., Daniel K. W. Chu, Eunice Y. C. Shiu, Kwok-Hung Chan, James J. McDevitt, Benien J. P. Hau, Hui-Ling Yen, et al. “Respiratory Virus Shedding in Exhaled Breath and Efficacy of Face Masks.” Nature Medicine 26, no. 5 (May 2020): 676–80.
  67. Lopez, German. “Why You Should Wear a Mask to Fight Covid-19, Explained by Several New Studies.” Vox, July 15, 2020.
  68. “Low-Cost Measurement of Face Mask Efficacy for Filtering Expelled Droplets during Speech | Science Advances.” Accessed September 10, 2020.
  69. Lukashev, Dmitriy, Boris Klebanov, Hidefumi Kojima, Alex Grinberg, Akiko Ohta, Ludmilla Berenfeld, Roland H. Wenger, Akio Ohta, and Michail Sitkovsky. “Cutting Edge: Hypoxia-Inducible Factor 1α and Its Activation-Inducible Short Isoform I.1 Negatively Regulate Functions of CD4+ and CD8+ T Lymphocytes.” The Journal of Immunology 177, no. 8 (October 15, 2006): 4962–65.
  70. Lyu, Wei, and George L. Wehby. “Community Use Of Face Masks And COVID-19: Evidence From A Natural Experiment Of State Mandates In The US.” Health Affairs 39, no. 8 (June 16, 2020): 1419–25.
  71. MacIntyre, C. Raina, Simon Cauchemez, Dominic E. Dwyer, Holly Seale, Pamela Cheung, Gary Browne, Michael Fasher, et al. “Face Mask Use and Control of Respiratory Virus Transmission in Households – Volume 15, Number 2—February 2009 – Emerging Infectious Diseases Journal – CDC.” Accessed September 10, 2020.
  72. MacIntyre, C. Raina, and Abrar Ahmad Chughtai. “A Rapid Systematic Review of the Efficacy of Face Masks and Respirators against Coronaviruses and Other Respiratory Transmissible Viruses for the Community, Healthcare Workers and Sick Patients.” International Journal of Nursing Studies 108 (August 1, 2020): 103629.
  73. ———. “Facemasks for the Prevention of Infection in Healthcare and Community Settings.” BMJ 350 (April 9, 2015).
  74. MacIntyre, C. Raina, Holly Seale, Tham Chi Dung, Nguyen Tran Hien, Phan Thi Nga, Abrar Ahmad Chughtai, Bayzidur Rahman, Dominic E. Dwyer, and Quanyi Wang. “A Cluster Randomised Trial of Cloth Masks Compared with Medical Masks in Healthcare Workers.” BMJ Open 5, no. 4 (April 1, 2015): e006577.
  75. primarydoctor. “Masks Are Neither Effective nor Safe.” Accessed September 8, 2020.
  76. Psychology Today. “Masks (Still) Work: Debunking (More) Pseudoscience.” Accessed September 10, 2020.
  77. McCabe, Caitlin. “Face Masks Really Do Matter. The Scientific Evidence Is Growing.” Wall Street Journal, August 13, 2020, sec. Life.
  78. Mitchell, N. J., and S. Hunt. “Surgical Face Masks in Modern Operating Rooms—a Costly and Unnecessary Ritual?” Journal of Hospital Infection 18, no. 3 (July 1, 1991): 239–42.
  79. Institute for Health Metrics and Evaluation. “New IHME COVID-19 Model Projects Nearly 180,000 US Deaths,” June 24, 2020.
  80. Offeddu, Vittoria, Chee Fu Yung, Mabel Sheau Fong Low, and Clarence C. Tam. “Effectiveness of Masks and Respirators Against Respiratory Infections in Healthcare Workers: A Systematic Review and Meta-Analysis.” Clinical Infectious Diseases 65, no. 11 (November 13, 2017): 1934–42.
  81. Oran, Daniel P., and Eric J. Topol. “Prevalence of Asymptomatic SARS-CoV-2 Infection.” Annals of Internal Medicine 173, no. 5 (June 3, 2020): 362–67.
  82. Safety News Alert. “OSHA: Cloth Masks Don’t Cause Harmful CO2 Levels,” August 12, 2020.
  83. ResearchGate. “(PDF) A Complete Debunking of Denis Rancourt’s Mask Don’t Work.” Accessed September 9, 2020.
  84. ResearchGate. “(PDF) The Efficacy of Medical Masks and Respirators against Respiratory Infection in Health Workers.” Accessed September 10, 2020.
  85. ResearchGate. “(PDF) Universal Masking Is Urgent in the COVID-19 Pandemic: SEIR and Agent Based Models, Empirical Validation, Policy Recommendations.” Accessed September 10, 2020.
  86. Psychology Today. “People Who Don’t Wear Masks Misunderstand Coronavirus Spread.” Accessed September 10, 2020.
  87. Person, E., C. Lemercier, A. Royer, and G. Reychler. “[Effect of a surgical mask on six minute walking distance].” Revue Des Maladies Respiratoires 35, no. 3 (March 2018): 264–68.
  88. Psychology Today. “Personality and Our Willingness to Wear Masks.” Accessed September 10, 2020.
  89. Pike, Lili. “Why 15 US States Suddenly Made Masks Mandatory.” Vox, May 29, 2020.
  90. Presstv. “Masks Get Credit for Protecting a Conservative Community.” Video. PressTV. PressTV. Accessed September 10, 2020.
  91. Radonovich, Lewis J., Michael S. Simberkoff, Mary T. Bessesen, Alexandria C. Brown, Derek A. T. Cummings, Charlotte A. Gaydos, Jenna G. Los, et al. “N95 Respirators vs Medical Masks for Preventing Influenza Among Health Care Personnel: A Randomized Clinical Trial.” JAMA 322, no. 9 (September 3, 2019): 824–33.
  92. Rancourt, Denis G. “Masks Don’t Work: A Review of Science Relevant to Covid-19 Social Policy,” June 1, 2020.
  93. Rengasamy, Samy, Benjamin Eimer, and Ronald E. Shaffer. “Simple Respiratory Protection—Evaluation of the Filtration Performance of Cloth Masks and Common Fabric Materials Against 20–1000 Nm Size Particles.” The Annals of Occupational Hygiene 54, no. 7 (October 1, 2010): 789–98.
  94. Rouse, Barry T., and Sharvan Sehrawat. “Immunity and Immunopathology to Viruses: What Decides the Outcome?” Nature Reviews Immunology 10, no. 7 (July 2010): 514–26.
  95. Ryan. “When It Comes to Masks, There Is No ‘Settled Science.’” Text. Mises Institute, July 23, 2020.
  96. Shimasaki, Noriko, Akira Okaue, Ritsuko Kikuno, and Katsuaki Shinohara. “Comparison of the Filter Efficiency of Medical Nonwoven Fabrics against Three Different Microbe Aerosols.” Biocontrol Science 23, no. 2 (2018): 61–69.
  97. “SIMPLE METHOD OF ESTIMATING FIFTY PER CENT ENDPOINTS12 | American Journal of Epidemiology | Oxford Academic.” Accessed September 9, 2020.
  98. Smith, Adam. “Masks Are Important but No Cure-All: Prof. Tells of Way to Slow Covid Spread.” TheStreet. Accessed September 10, 2020.
  99. Smith, Jeffrey D., Colin C. MacDougall, Jennie Johnstone, Ray A. Copes, Brian Schwartz, and Gary E. Garber. “Effectiveness of N95 Respirators versus Surgical Masks in Protecting Health Care Workers from Acute Respiratory Infection: A Systematic Review and Meta-Analysis.” CMAJ 188, no. 8 (May 17, 2016): 567–74.
  100. News Break Boston, MA. “Some Hospitals Move To ‘Universal Mask’ Policy. Should Everyone Wear Masks In Public? | News Break.” Accessed September 10, 2020.
  101. The World from PRX. “Some Public Figures Eschew Masks. Scientists Say Wear Them.” Accessed September 10, 2020.
  102. Spencer, Saranac Hale. “Video Misrepresents the Science Behind Face Masks.” FactCheck.Org (blog), July 24, 2020.
  103. Staff, Reuters. “Dutch Government Will Not Advise Public to Wear Masks – Minister.” Reuters, July 29, 2020.
  104. Still Confused About Masks? Here’s the Science Behind How Face Masks Prevent Coronavirus | UC San Francisco. “Still Confused About Masks? Here’s the Science Behind How Face Masks Prevent Coronavirus.” Accessed September 10, 2020.
  105. News Break. “Sweden’s Equivalent to Dr. Fauci Says ‘it Is Very Dangerous’ to Believe Face Masks Are a Cure-All.” Accessed September 10, 2020.
  106. Fortune. “Sweden’s Top Virologist Has a Message on How to Defeat Coronavirus: Open Schools and No Masks.” Accessed September 10, 2020.
  107. The Skeptical Cardiologist. “The Economic Impact of Wearing Face Masks During COVID-19,” July 7, 2020.
  108. Psychology Today. “The Evidence on Face Masks.” Accessed September 10, 2020.
  109. “The Forgotten Science Behind Face Masks.” Accessed September 10, 2020.
  110. MSN. “This Face Mask Claim Is Going Viral—and It’s 100 Percent Wrong.” Accessed September 10, 2020.
  111. MSN. “This Is How Many People Need to Wear Masks to Stop the Coronavirus.” Accessed September 10, 2020.
  112. Tunevall, Th. Göran. “Postoperative Wound Infections and Surgical Face Masks: A Controlled Study.” World Journal of Surgery 15, no. 3 (May 1, 1991): 383–87.
  113. “Tyson Foods, Inc. Releases Covid-19 Test Results At Northwest Arkansas Facilities.” Accessed September 9, 2020.
  114. Viola, I. M., B. Peterson, G. Pisetta, G. Pavar, H. Akhtar, F. Menoloascina, E. Mangano, et al. “Face Coverings, Aerosol Dispersion and Mitigation of Virus Transmission Risk,” May 19, 2020.
  115. Wang, Xiaowen, Enrico G. Ferro, Guohai Zhou, Dean Hashimoto, and Deepak L. Bhatt. “Association Between Universal Masking in a Health Care System and SARS-CoV-2 Positivity Among Health Care Workers.” JAMA 324, no. 7 (August 18, 2020): 703–4.
  116. Wang, Yu, Huaiyu Tian, Li Zhang, Man Zhang, Dandan Guo, Wenting Wu, Xingxing Zhang, et al. “Reduction of Secondary Transmission of SARS-CoV-2 in Households by Face Mask Use, Disinfection and Social Distancing: A Cohort Study in Beijing, China.” BMJ Global Health 5, no. 5 (May 28, 2020).
  117. Ward, Alex. “How Masks Helped Hong Kong Control the Coronavirus.” Vox, May 18, 2020.
  118. Ward, John. “Stop Forcing People to Wear Useless Masks.” The Slog (blog), July 24, 2020.
  119. Fortune. “‘We See No Point in Wearing a Face Mask,’ Sweden’s Top Virus Expert Says as He Touts the Country’s Improving COVID Numbers.” Accessed September 9, 2020.
  120. “Wearing a Mask: Myths and Facts.” Accessed September 10, 2020.
  121. “Welcome to CDC Stacks |.” Accessed September 10, 2020.
  122. ResearchGate. “What’s Your Point towards Facemask Usage under COVID-19?” Accessed September 9, 2020.
  123. Wu, Katherine J. “Masks May Reduce Viral Dose, Some Experts Say.” The New York Times, July 27, 2020, sec. Health.
  124. Xiao, Jingyi, Eunice Y. C. Shiu, Huizhi Gao, Jessica Y. Wong, Min W. Fong, Sukhyun Ryu, and Benjamin J. Cowling. “Nonpharmaceutical Measures for Pandemic Influenza in Nonhealthcare Settings—Personal Protective and Environmental Measures – Volume 26, Number 5—May 2020 – Emerging Infectious Diseases Journal – CDC.” Accessed September 8, 2020.
  125. Psychology Today. “Yes, Masks Work: Debunking the Pseudoscience.” Accessed September 10, 2020.
  126. UC Davis. “Your Mask Cuts Own Risk by 65 Percent,” July 6, 2020.
  127. z3508948. “Cloth Masks – Dangerous to Your Health?” Text. UNSW Newsroom, April 23, 2015.
  128. Zajenkowski, Marcin, Peter K. Jonason, Maria Leniarska, and Zuzanna Kozakiewicz. “Who Complies with the Restrictions to Reduce the Spread of COVID-19?: Personality and Perceptions of the COVID-19 Situation.” Personality and Individual Differences 166 (November 1, 2020): 110199.


Randomized Controlled Trials and Experimental Evidence

I am surprised to find that there is so much material on the limitations of randomized controlled trials (RCT). It is funny that this knowledge has not reached the consciousness of many specialists in the medical community.

In order to understand randomized controlled trials, it helps to understand experimental research methods in general. There are big issues 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. The discussions become very technical. All scientific evidence is underdetermined in some manner; that is another way of saying that our understanding is confounded. One study does not establish a case; it only points in a certain direction.

A Cheat Sheet on Key Ideas Underlying Research

Below is a cheat sheet on some key scientific ideas, of relevance to research, including randomized controlled trials. It may seem peripheral to the topic of RCT, but I think that understanding some basic issues around research and inference will help in better understanding the documents discussed in the second part of the essay.


Epistemology is the study of knowledge. The philosophy of science applies epistemological thinking to scientific research. Those espousing methods of research should really have some familiarity with this discipline, since it underpins science.


Inference is the process of making a judgment or buttressing an argument from available evidence. It has three varieties:

  1. Deduction is the method of applying the established patterns of formal logic to assertions to assess whether conclusions follow correctly from the premises. There is no guarantee that the original premises are correct, are sound.
  2. Induction is the process of generalizing from past experience to predict future events based on perceived patterns, perceived regular occurrences.
  3. Abduction is sometimes called “inference to the best explanation.”

Scientific evidence

One study does not establish a case; it only points in a certain direction. All scientific evidence is underdetermined. Evidence follows these dictates:

  1. It must be obtained, either produced or found
  2. It must be evaluated for reliability, correctness, provenance
  3. It must be interpreted, the implications made clear, the fit within an existing body of knowledge examined

Is there scientific objectivity? All of this assessment of evidence happens within the context of current beliefs, scientific and other, and biases. It could not be otherwise.


Probabilities are the odds of future events happening. They can be based on deduction and counting, or based on intuition and conjecture, possibly well-informed, but subjective.

Statistics are generally classed as descriptive or inferential. In descriptive statistics, data is collected, sorted, categorized and summarized in various mathematical ways. In inferential statistics, statistics based on samples are generalized to larger populations of interest, based on the odds of any observed results being true.

Frequentist thinking looks at chances as frequencies, or proportions, in similar events or items.

Bayesian thinking looks at prior probabilities, determined in some fashion, and applies the rules of conditional probability to assess fresh probabilities.

Inferential statistics reasons from sample to populations. From samples we can make predictions about the broader population from which the samples are drawn. This has problematic aspects.


Association lets us see that certain things seem to occur together with regularity.

Correlation gives us a measure of how well, how often this association holds. Mathematically a correlation of zero says that there is no relationship, a correlation of positive one says that they are perfectly correlated, always going together, and a correlation of negative one says that they are perfectly inversely correlated.


Causation gives us the idea that this association is one in which one factor depends, to a lesser or greater extent, on a second factor. By varying the first factor, the independent factor, we can produce a repeatable change in the second factor, the dependent factor. We can quantify these factors and abstract them, or operationalize them, and call them variables.


Scientific research methods do not necessarily involve experimental studies, or laboratory work. There are many fields where experiment plays a secondary role.

However, in many fields, research does involve the manipulation of various independent factors in order to see the effects on assumed dependent factors. In general, the experiment is designed to test a research hypothesis, which may be part of a larger theory. In order to conduct experiments, certain standard methods have been developed in order to design experiments which have a good chance of providing correct results and allowing for interpretation. This interpretation is always done within the context of a broader set of beliefs about the nature of the research area.

One of the key aspects of all research is that the factors being manipulated are not necessarily the factors determining the experimental outcomes. We call factors which might be affecting the outcome and which are not being manipulated confounders, or confounds. These possible confounds may be identified and controlled for to some extent through good research design. However, not all confounds will be identified, and cannot be controlled for so easily. Matching and stratifying across subgroups on known factors and randomization across subgroups are mechanisms used to control for confounds. There is a lot more to research design than this, but these ideas are basic.

It is sometimes said that randomization controls for unconscious bias and for biasing factors independent of human judgment.  This is at least partially true. We can regard bias as a set of confounding factors. Bias can occur at all stages of a study, from sample selection, to recording of data, analysis of data, and interpretation of results. Randomization will not help with all of these sorts of bias.

By making the subjects, if human, unaware of the experimental group that they are in, a certain sort of bias can be controlled. This is called a blind trial. By making the experimenters unaware of the groups, we can remove some experimenter bias. This, combined with the first method, is called a double blind trial. There are cases where this works, but there is a gap between theory and practice.

Research Samples

In performing an experiment, subjects are required. This means that they must be selected in some fashion. There will be at least two groups in a well designed experiment, a control group and a treatment group. If the sample control group is different on some significant confounding factor from the sample treatment group, we can end up with worthless results due to this bias. We can help control for this confound by matching across groups on factors considered important such as age, sex, weight and so on. We can also assign subjects to the different groups on some randomized basis. We can combine these strategies. In order to have some confidence in our results, we should use the largest samples we can obtain. Randomization is not particularly effective as a strategy for small sized groups.

We can have unconscious bias in our sample selection, and end up with groups that are not equivalent in key dimensions. We do not want to use ad hoc methods of assigning subjects to a group, or in obtaining subjects for the sample, but real life contingencies such as funding, time frames, available subjects, and other things often get in the way of experimental rigour.

Integrity and Research Design

Experimental design cannot control for dishonesty, for deception. This is worse than bias, for it can not be detected in a reliable fashion, and research designs can not control for it.

RCT major themes

There seem to be a number of significant considerations for the use and interpretation of randomized controlled trials in research, and arguments for the use of other methods in many cases. This is not to say that RCTs do not have an important role to play in research, but they are just one of various methods.  For further reading, see Medicine’s fundamentalists and Randomized controlled trials.

I will not attempt to summarize such a voluminous literature on RTC, but instead will focus on a few articles, published in journals, by respected researchers. The first is by Thomas R. Frieden, M.D.,M.P.H., a former director of the Center for Disease Control and Prevention. In the New England Journal of Medicine he writes “Evidence for Health Decision Making – Beyond Randomized, Controlled Trials.”

The second is by Angus Deaton, FBA, Dwight D. Eisenhower Professor of Economics and International Affairs Emeritus at the Princeton School of Public and International Affairs and the Economics Department at Princeton University and a winner of the Nobel Memorial Prize in Economic Sciences and by co-author Nancy Cartwright, FBA FAcSS, Professor of Philosophy at Durham University and a Distinguished Professor at the University of California, San Diego (UCSD). In Social Science & Medicine, they write, “Understanding and misunderstanding randomized controlled trials.”

I also reference in the Bibliography a piece Alexander Krauss in the Annals of Medicine,Why all randomised controlled trials produce biased resultsand a response by Althouse, Andrew D., Abebe, Kaleab Z. , Collins, Gary S. & Harrell Jr, Frank E. , Journal Annals of Medicine,  Response to “Why all randomized controlled trials produce biased results”, without attempting commentary.

Evidence for Health Decision Making – Beyond Randomized, Controlled Trials

In this paper by a healthcare professional, randomized controlled trials are discussed with respect to benefits and limitations, and other methods of gathering evidence for medical research are presented, along with considerations for use.

From the paper by Frieden (above), the author makes the following points (précised here):

  1. There is no single, best approach to the study of health interventions
  2. Clinical and public health decisions are almost always made with imperfect data
  3. We should be promoting transparency in study methods
  4. We should be ensuring standardized data collection for key outcomes
  5. We need to use new approaches to improve data synthesis
  6. Improved data synthesis provides critical steps in the interpretation of findings
  7. Improved data synthesis allows us to better identify data for action
  8. It must be recognized that conclusions may change over time
  9. There will always be an argument for more research and for better data
  10. Waiting for more data is often an implicit decision not to act or to act on the basis of past practice rather than best available evidence
  11. The goal must be actionable data — data that are sufficient for clinical and public health action
  12. We need methods which produce data that have been derived openly and objectively
  13. We need data which enable us to say, “Here’s what we recommend and why.”

Understanding and misunderstanding randomized controlled trials

In this paper by a Nobel prize winning economist and by co-author who is a professor of philosophy discuss various issues in research and in the use of randomized controlled trials.

From the paper by Deaton and Cartwright (above), the authors make the following points:

  1. Randomization does not balance confounders in any single trial.
  2. Unbiasedness is of limited practical value compared with precision.
  3. Asymmetric distributions of treatment effects pose threats to significance testing.
  4. The best method depends on hypothesis tested, what’s known, and cost of mistakes.
  5. RCT results can serve science but are weak ground for inferring ‘what works’.


Althouse, A. D., Abebe, K. Z., Collins, G. S., & Harrell, F. E. (2018). Response to “Why all randomized controlled trials produce biased results.” Annals of Medicine, 50(7), 545–548.
Deaton, A., & Cartwright, N. (2018). Understanding and misunderstanding randomized controlled trials. Randomized Controlled Trials and Evidence-Based Policy: A Multidisciplinary Dialogue, 210, 2–21.
Frieden, T. R. (2017). Evidence for Health Decision Making—Beyond Randomized, Controlled Trials. New England Journal of Medicine, 377(5), 465–475.
Krauss, A. (2018). Why all randomised controlled trials produce biased results. Annals of Medicine, 50(4), 312–322.