Medical Research
Interpretations of Medical Research
Hiearchies of Evidence
Perhaps as a simplified heuristic, it has become common for some medical researchers and physicians to refer to one category of evidence as superior to another. However, this is incorrect both logically and statistically. Trial design and statistical evaluation can and often do invert the quality and meaning of evidence in such hierarchies.
- How to Rig Research by Statistically Stacking the Deck (A Simpson's Paradox Tale) How evidence of efficacy, such as that of hydroxychloroquine's efficacy, gets covered up through the mixing of pools of patients treated under different protocols.
Clinical Trials
There are many people who suggest that randomized control trials (RCTs) are both necessary to form conclusions and necessarily superior to observational control trials (OCTs). However, medical literature does not support this RCT fundamentalism.
- Randomized Clinical Trials and Observational Studies Are More Often Alike Than Unlike1)
- RCTs and OCTs show similar results in Oncology trials2)
- A Critique of RCTs: The Gold Standard is Neither Supreme nor Ultimate explains why randomized control trials (RCTs) should not be viewed as the ultimate standard of medical evidence.
- A Critique of RCTs: Historical Failure to Strike Gold reviews literature demonstrating that RCTs tend to show the same results as observational evidence of medical effects.
Controversies
Animal Experiments
1)
October, 2014 | Joseph S. Ross, MD, MHS | Editor's note in JAMA Intern Med. | Randomized Clinical Trials and Observational Studies Are More Often Alike Than Unlike | doi:10.1001/jamainternmed.2014.3366
2)
May 10, 2019 | Payal D. Soni et al | Journal of Clinical Oncology | Comparison of Population-Based Observational Studies With Randomized Trials in Oncology | DOI: 10.1200/JCO.18.01074