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Comment by gorgoiler | Hacker News Reader

Is it typical for clinical trials to completely miss the point like this? I’d like to read a followup meta-analysis that focuses on the actual physiology — “Parachute use to prevent death … when hitting the ground”.

[shurely some mistake?]

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I don't think it's missing the point, but you do want to be aware of the context a little bit. Randomized controlled trials are often held up as the gold standard of evidence, and they are good when it is possible to carry them out, but the point of the linked study is that the kinds of treatments it is possible and ethical to perform RCTs for limit their applicability. In this case, it would be unethical and criminal to get volunteers to jump off airplanes at 10,000ft with placebo parachutes, and the kind of RCT it is possible to carry out (this study) does not show parachutes to be effective. Thus no RCT showing that parachutes are effective is possible.

I had Hodgkins Lymphoma when I was younger. Because we've been successfully treating Hodgkins for so long we don't have RCTs for the basic idea of the treatment. We can observe that people who choose not to be treated tend to die (but that might be for some other reason, they weren't randomised) and we have modern studies comparing one therapy to another as it has advanced, e.g. I got ABVD, I'm not sure what the current gold standard is - but it would be unethical to run the basic RCT now. "We're going to randomly kill some people just to prove that we were right".

It is you that missed the point, read the conclusions again and realise this is a statement about medical papers and randomized participants.

What do you mean? The point is identifying if parachutes prevent death when jumping from air aircraft, it's in the title!

Perhaps it was intended as part of the satire. A whole new set of trials will be needed, from scratch, to investigate deaths caused by base jumping from cliff tops!

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