Clinical trials Complementary and alternative medicine Medicine Quackery

How long before I run out of variations on the same lame joke about answering my Seed overlords?

It seems a reasonable question to ask, given my propensity for it.

Unfortunately that’s not what our Seed overlords asked this week. This week, they ask:

If you could shake the public and make them understand one scientific idea, what would it be?

Predictably, some ScienceBloggers answered: evolution and what it really means, not the parody of evolution presented by creationists or the simplistic version of it that is often taught in school or discussed in the mainstream media. I can’t argue with that answer, but I’m a physician; so my answer will be different:

If I could get the public to understand one scientific idea, it would be the concept of clinical trials. In particular, I would want to make them understand why most anecdotal evidence is a very poor guide to determining what treatments are effective, thanks to the placebo effect, confirmation bias, and regression to the mean (all of which I discussed here), among other confounding factors. I would want them to understand the hierarchy of evidence in evidence-based medicine, and why double-blinded, placebo-controlled, randomized clinical trials (RCTs) are the strongest evidence, while retrospective studies are weaker, and case reports are the weakest of all. Finally, I would want them to understand that lesser evidence should only be used to guide treatment choices only in the absence of stronger evidence (RCTs), particularly for questions where doing a true RCT would be unethical.

An understanding of these concepts would go a long way towards decreasing the susceptibility of the public to the sales pitches of quacks and inject a healthy dose of skepticism towards the claims of pharmaceutical companies for their latest, greatest wonder drugs, as well.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

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