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Re: Science has a new methodology

One of the problems you face in dismissing all epidemiology out of hand is that it is not ethically acceptable to perform randomized controlled trials on subjects for a treatment which is known or strongly suspected to cause harm. "Not ethically acceptable", by the way, means you simply can't do the trial. Ever.

You are never going to have a randomized trial for cigarette smoking, for example. You'll probably never have a randomized trial for lard eating either. Besides being unethical, such studies are impossible to blind, and will have a highly selected population under treatment. The "gold standard" is unattainable whichever way you look at it.

Even in clinical trials it is often impossible to perform blinding, randomization is merely the least worst available method for controlling stochastic effects, and it is certainly impossible to have a subject sample that is truly representative of the population.

Sure, a single experiment done properly can produce more robust and trustworthy results than ten non-interventional observations, but don't assume either that all experiments are done properly or that all observations are complete twaddle. Experiments can be junk and observational studies can be good, even if the inverse is more usually true.

Just because we don't have an RCT for smoking doesn't mean we don't know that smoking causes lung cancer - we just know this with (very) slightly less certainty than if it were possible to carry out the RCTs.

Re: Re: Science has a new methodology

I agree with what you say, but this the origins of a murky area of life. Torture is reprehensible and we should avoid it all all costs. Occasionally though, all cost situations arise, and men in the field choose to exercise what we in our armchairs might consider torture.

Randomized controlled studies should remain the standard. When they are possible, we exercise our judgement.

As Brignell has pointed out in his book, we don't know that smoking "causes" the cancer any more than fertilizer causes tomatoes to grow. It is pretty clear that if you want to avoid lung cancer, avoiding smoking is a good idea. Most smokers though roll the dice on this one and WIN. We can never forget that 11 out of 12 smokers WIN the dice roll on lung cancer. Start getting into RRs significantly less than 23 (and just about all are < 2), and you are in areas where people WIN 99% of the time.

Leaning on such studies is foolish. It may be necessary from time to time, but it should not become mainstream.

Re: Science has a new methodology

I think scientific method in medicine may have been in a compromised state for some time.

http://junkfoodscience.blogspot.com/2008/11/when-news-sounds-too-good-statins-new.html


Yet another trial stopped early.

I would guess that the drug manufacturers are gambling that the worst case scenario of being sued for supplying a product later discovered to be less efficacious than claimed (or worse) will be more than balanced by the earnings prior to any claim and that perpetual inflation would discount the value of any penalty by the time settlement had to be made to the injured party's Estate.

If these are the standards by which supposedly full process trials are performed then I see no reason not to accept any epidemiological studies as equally valued the that value may be small.

Bear in mind humanity tends to believe in 'old wives' tales and the like for 'real' and 'natural' treatments and we might as well abandon the scientific method and go with consensus gut feel. I'm sure people would feel more comfortable with that.

All good preparation for the return to non-industrialised living.


Grant