Evidence Based Medicine

Here Trisha Greenhalgh, an actual expert, writes what I have been trying to write. In a Twitter thread.

Please click the link.

Two key tweets

But the principle of waiting for the definitive RCT [randomized controlled Trial] before taking action should not be seen as inviolable, or as always defining good science. On the contrary, this principle, inappropriately applied, will distort our perception of what “good science” is.

This explains with less than 280 characters what I was trying to say in “What has science established”. I am quite sure that she is correctly desscribing a widespred view that “waiting for a definitive RCT” defines “good science”. Clearly this is a category error. Science does not tell us what to do. It might tell us what will happen if we do things, but it is not a moral code. “First do no harm” is ethics not science. Good science requires recognizing what is not known, it does not have anything to do with the argument “we don’t know and therefore we should”. The principle however applied is not consistent with knowing what science is let alone knowing what good science is.

The scientific method, professional ethics and the Federal Food, Drug, and Cosmetic Act are all sets of rules that some people should follow. But they aren’t different aspects of the same entity, they aren’t different parts of one organic whole. Following Adam Smith, I think laws have been internalized to fear and obedience, then respect, then internaliztion so what was the letter of law becomes the voice of concience.

But, of course, the main point is

More specifically, taking a “primum non nocere” (= don’t act till we’ve got RCT certainty) stance when hundreds are dying daily makes no scientific or moral sense. It is neither scientifically nor morally reckless to try out policies that have a plausible chance of working