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I love how @ChrisMasterjohn’s arguments for why RCTs are not necessary for health interventions is that RCTs are not used to make decisions in everyday life, so why should we need them for medicine? We should just apply a risk-benefit-calculation. This reasoning is fallacious1/n
First of all, health interventions are not everyday life decisions. Inasmuch as they can produce powerful benefits, they are equally likely to have large risks, especially if they have been poorly studied. 2/n
Medicines and supplements are in a word potentially dangerous, expensive, and costly, unlike which pizza we decide to microwave. We know this now from the RCT literature. 3/n
Second, how do you make a risk-benefit calculation on a treatment that hasn’t actually been studied in humans? The answer is that you can’t. 4/n
You could try to speculate your way to knowledge of benefits and risks but this is how traditional medicine was practiced and we now know from clinical trial evidence that this mode of clinical reasoning is misleading to the point of comedy, 5/n
if the harm inflicted on patients was not so tragic. Examples of this abound, are in the literal hundreds of established practices even into the 21st century, and likely constitute between 30-40% of the practice of current medicine. 6/n
That’s practices whose mechanistic plausibility have convinced the entire profession, not just the sole hypothetical speculations of Chris Masterjohn living in his grandma’s basement. 7/n
It gets worse when we consider groundbreaking basic science discoveries that are indeed based on the same type of rationale as Chris’s. Only between 1 and 20% ever make it through the gauntlet of the RCT and are shown safe and effective. 8/n
We know therefore that Chris’s wild speculations are highly unlikely to be safe and effective on average, and are likely to consist of placebos with a steep attached consulting fee and risk of harm. 9/n
What you do @ChrisMasterjohn is grift and should be illegal. It is based on a total lack of understanding about how clinical evidence works or a realistic concern for patient/client welfare and on a 19th century model of medical decisionmaking that is no longer valid. 10/n
Indeed the entire popular health industry is dominated almost entirely by your type, is illegitimate, is pure misinformation and quackery, and must be curtailed or eliminated entirely if we care at all about the public being able to make informed decisions about its health. 11/11
