Harvey Risch is physician and a Professor Emeritus of Epidemiology at Yale School of Public Health and Yale School of Medicine. His recent critique of The ScienceTM contains so many bombshells, I struggled to pick highlights. But hopefully these snippets will entice you to click through and read the whole thing.1It gets technical at times. But you don’t need to understand all the numbers to understand his points about Randomized Controlled Trials.
… plausible theories are easy to believe, and that is the problem. That is what we have been fed for almost three years of the Covid-19 pandemic. In fact though, we have been fed plausibility instead of science for much longer…
Cargo-Cult Science
[Nobel Laureate Richard Feynman delivering the 1974 Caltech commencement address]… described how South Sea Islanders, after World War II, mimicked US soldiers stationed there during the war who had guided airplane landings of supplies. The island residents, using local materials, reproduced the form and behaviors of what they had witnessed of the American GIs, but no supplies came.
In our context, Feynman’s point would be that until a theory has objective empirical evidence bearing upon it, it remains only a theory no matter how plausible it may seem to everyone who entertains it. The Islanders were missing the crucial fact that they did not understand how the supply system worked, in spite of how plausible their reproduction of it was to them…
Evidence-Based Medicine
There is perhaps no bigger plausibility sham today than “evidence-based medicine” (EBM)…
Over time, the EBM approach to selectively considering “best” evidence seems to have been “dumbed down,” first by placing randomized controlled trials (RCTs) at the top of a pyramid of all study designs as the supposed “gold standard” design, and later, as the asserted only type of study that can be trusted to obtain unbiased estimates of effects. All other forms of empirical evidence are “potentially biased” and therefore unreliable. This is a plausibility conceit as I will show below.
But it is so plausible that it is routinely taught in modern medical education, so that most doctors only consider RCT evidence and dismiss all other forms of empirical evidence. It is so plausible that this author had an on-air verbal battle over it with a medically uneducated television commentator who provided no evidence other than plausibility (Whelan, 2020): Isn’t it “just obvious” that if you randomize subjects, any differences must be caused by the treatment, and no other types of studies can be trusted? Obvious, yes; true, no…
Harvey Risch2“@”Harvey Risch, Senior Scholar at Brownstone Institute, is a physician and a Professor Emeritus of Epidemiology at Yale School of Public Health and Yale School of Medicine. His main research interests are in cancer etiology, prevention and early diagnosis, and in epidemiologic methods.”
- 1It gets technical at times. But you don’t need to understand all the numbers to understand his points about Randomized Controlled Trials.
- 2“@”Harvey Risch, Senior Scholar at Brownstone Institute, is a physician and a Professor Emeritus of Epidemiology at Yale School of Public Health and Yale School of Medicine. His main research interests are in cancer etiology, prevention and early diagnosis, and in epidemiologic methods.”