Parachute use to prevent death jumping from aircraft: random controlled trial (2018)
bmj.com
bmj.com
Conversely, we shrink it for particularly substantive and unpredictable submissions, especially if they didn't get huge attention in the past, which is partly what keeps them unpredictable.
Edit: here's a great example of that:
To those who say that we need thirty multicenter studies and a thousand patients included, I answer that if we were to apply the rules of current methodologists, we would have to redo a study on the interest of the parachute. Take 100 people, half with parachutes and the other without and count the dead at the end to see what is most effective. When you have a treatment that works against zero other treatment available, this treatment should become the benchmark. And it's my freedom to prescribe as a doctor. We don't have to obey government orders to treat the sick. The recommendations of the High Health Authority are an indication, but it does not oblige you. Since Hippocrates, the doctor has done for the best, in the state of his knowledge and in the state of science.
https://translate.google.com/translate?sl=fr&tl=en&u=https%3...
https://en.wikipedia.org/wiki/Didier_Raoult#Ban_from_publish...
> In 2006, Raoult and four other co-authors were banned for one year from publishing in the journals of the American Society for Microbiology, after a reviewer for Infection and Immunity discovered that two images in a figure from the revised manuscript of a paper about mouse modelling for typhus were identical to figures from the originally submitted manuscript, even though they were supposed to represent a different experiment.
https://blogs.sciencemag.org/pipeline/archives/2020/03/29/mo...
If you get infected, would you take it, or would you wait and see the result of the full study?
Now imagine having to take that decision not just for your life, but for your patients, and all the 200 staff that work in your hospital.
Another way to view the situation: you are a policeman stopping an ambulance not respecting the driving code and driving too fast, and then learn there is a dying patient in the back, what do you do?
Tell the ambulance driver to turn on the siren and party lights and have a nice day.
Like, there are already exemptions for ambulances driving "recklessly" as long as they're indicating (via siren and lights) that they're doing so in an emergency situation.
On that note, though, if the ambulance is driving too recklessly it might do more harm than good to the patient. It wouldn't necessarily be the police officer's place to make that determination, but it could certainly be a contributing factor for reprimanding the ambulance driver should the patient end up more injuries coming out of the ambulance than one did getting in.
Overall, a pretty poor analogy IMO, even if I do (to an extent) agree with your point.
You're basically asking us to take his word for it because he happens to be treating covid patients. That is not a thing.
The people on the front lines often don't have a great view of the entire battlefield.
There's a good reason the general is typically at a command post a ways back from it.
> Conclusions Parachute use did not reduce death or major traumatic injury when jumping from aircraft in the first randomized evaluation of this intervention. However, the trial was only able to enroll participants on small stationary aircraft on the ground, suggesting cautious extrapolation to high altitude jumps. _When beliefs regarding the effectiveness of an intervention exist in the community, randomized trials might selectively enroll individuals with a lower perceived likelihood of benefit, thus diminishing the applicability of the results to clinical practice._
I wonder what else that's applicable to?
The study is an absolutely ingenious way of simultaneously illustrating multiple different challenges that can frustrate randomized controlled clinical trials. Some highlights:
> We believe that randomisation is critical to evaluating the benefits and harms of the vast majority of modern therapies, most of which are unlikely to be nearly as effective at achieving their end goal as parachutes are at preventing injury among people jumping from aircraft.
> RCTs are vulnerable to pre-existing beliefs about standard of care, whether or not these beliefs are justified
> When strong beliefs about the standard of care exist in the community, often only low risk patients are enrolled in a trial, which can unsalvageably bias the results, akin to jumping from an aircraft without a parachute.
> even a well conducted RCT can provide misleading results
> Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials [1]
Hence I use an airbag suit.
* https://en.wikipedia.org/wiki/Cirrus_Airframe_Parachute_Syst...
You'd be fine ;)
It sounds like a lot more fun.
Edit: Silly me. It turns out that while BMJ is a legit journal, the study itself is satire and does identify itself as such near the end and via a linked opinion.
> Linked opinion: We jumped from planes without parachutes (and lived to tell the tale)
"The PARACHUTE trial is our satirical attempt at bringing the parachute, as well as the almighty RCT, back down to earth."
Fortunately, some folks are doing actually high quality research on this right now, so we should have more solid evidence on this topic soon.
It probably has nothing to do with the current situation, barring a time machine, which should probably get its own article.
For anyone just upvoting or discussing this because they thought it was funny or interesting, more power to them.