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Comment by tensor | Hacker News Reader

Drug company bias is definitely a well known issue. But there are even bigger issues with science based medicine.

* MDs are not PhDs for one, though people often equate the two.

* Things like surgery is in fact hard to test. There are ethical issues around it. E.g. are you really going to do a shame surgery "for science" if you think there is a chance it might save the patients life? On the flip side, surgery has a lot of risk, and performing surgery that doesn't work exposes patients to unnecessary risk.

* There are entire fields where pseudo-science is common. Notably a lot of physical therapy and chiropracty is not science based.

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On the difficulty of testing lifesaving treatments, there's a great paper on this topic:

"Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials" [0]

It has some great gems like:

  - No randomised controlled trials of parachute use have been undertaken

  - The basis for parachute use is purely observational, and its apparent efficacy could potentially be explained by a “healthy cohort” effect

  - Individuals who insist that all interventions need to be validated by a randomised controlled trial need to come down to earth with a bump

[0] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC300808/

There was, subsequently, published a Christmas BMJ article reporting the results of an RCT of parachute use jumping from planes. Apart from a few minor confounding problems with selecting the participants, it's very good science! Found no evidence of benefit, sadly...

https://www.bmj.com/content/363/bmj.k5094

So funny!

> RESULTS Parachute use did not significantly reduce death or major injury (0% for parachute v 0% for control; P>0.9). This finding was consistent across multiple subgroups. Compared with individuals screened but not enrolled, participants included in the study were on aircraft at significantly lower altitude (mean of 0.6 m for participants v mean of 9146 m for non-participants; P<0.001) and lower velocity (mean of 0 km/h v mean of 800 km/h; P<0.001).

> 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.

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