RCTs and evidence based medicine are overrated

[Mithriel]

I have been reading these twitter threads with great interest.

He says

We in medicine deserve the derision of physicists and engineers. Our education leaves us reduced to repeating medical school teachings on "EBM" as if this transforms lies into truths—in ignorance of the fact that physics is considered the model science.

then goes on to explain why.

Also

He says

Recent release of the N95 vs medical mask study raises a whole bushel of serious issues, ethics to study design to COI failures. There’s a more fundamental issue that isn’t widely addressed: should an evidence based medicine (EBM) approach even be considered valid for such work?

Eye opening

 

[Mithriel]

Exactly. yet the likes of Peter White are still insisting that since their PACE trial (erroneously claimed to be an RCT) did not show evidence of harms the claims from thousands of patients are not scientific.

And completely missing the point that a trial based on asking patients to fill out questionnaires about their symptoms is no more reliable than a survey asking patients about their symptoms. Even if those who answer are self selected the absolute number is too high to ignore.

 

[rvallee]

There is no evidence-based engineering
There is no evidence-based computer science
There is no evidence-based plumbing
There is no evidence-based accounting
There is no evidence-based anything

Because in every single profession other than medicine we use nothing that hasn't been proven to work before anyone started using it. The difference is that we have ways to evaluate whether something works, and actually care about what's true and what isn't, while medicine has developed a model built on an illusion of working that satisfies the professionals.

No other profession would be satisfied with something as mediocre as this, for the simple fact that it would straight up not work. It's not possible to get away with building bridges that fall down, plumbing systems that barely work or electrical systems that are a constant fire hazard. It's not even that you'd lose your job or go bankrupt, no one is taught to do this, because it would straight up never work.

Medicine is the only profession where you can get away with lies, and it's precisely because it's still stuck in an infant stage where they think that their perception is, somehow, objective, as long as they have performative steps to it.

The entire EBM paradigm needs to end. It inevitably will, but I will do everything I can to bring its end sooner than later. It has effectively stagnated medical science and actually represents a threat to our civilization. It also ruined my life, and I take that very personally. But it also ruined millions of lives, and I also take that very personally. I just don't like people who harm others.

 

[Mithriel]

I don't think it is individual doctors as such. They are presented with "evidence" outwith their speciality and believe it. The whole idea of evidence based medicine seems self evident and they do not know the evidence is not trustworthy.

What is wrong is that the research side is presenting mediocre and dangerous ideas to the profession. We have seen how the BPS coterie hide behind superficial trappings of scientific respectability which is why they can claim we are antiscience.

The real question is how they get away with it. Now we get into conspiracy modes but it is well established what the tobacco companies did and the US committees which investigated the methods of the CIA found mechanisms of pushing their world view that are staggeringly similar to what we see happening to us.

Put some money in, give a gentle nudge here and there and you get key players into a position of influence then the system runs itself.