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Comment by hellerbarde | Hacker News Reader

I was about to write something similar. Thanks for formulating it so eloquently. I think it's this part that trips up some people:

> [...] at a minimum it unblinds the doctors on the ground.

It's very important that the person administering the drug/monitoring the patient can not tell the difference.

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The effects of unblinded doctors can be catastrophic and might not even be discovered.

There was one study where a drug was designed to improve motor response in patients with retarded motor skills. The doctors had found a way to determine which patient was receiving which drug.

So when it came time for the doctors to measure efficacy of the drug, they would do the motor skills test. If the patient was on the actual drug, and didn't show improvement, the doctors had a tendency to say things like "Well, that can't be right. Let me run the test again."

Disaster. Hundred million dollar trial down the toilet.

"The doctors had found a way to determine which patient was receiving which drug." - This implies that they consciously tried to bypass their blindness, physical design of the pill being different would do this sure, but that's not an issue with too much disclosure, that's an issue with people either A) Not doing their job well enough(the pill designers) OR B)Trying to find out which one so they could fudge the results.(Crooked Doctors? Yeah, less disclosure will fix that right up.)

You're attributing to malice what is more likely stupidity. Doctors with patients on experimental trials want the drugs to succeed. They expect the drugs to succeed. That impacts their evaluations.

If I were a doctor participating in a study like this, I'd have a really hard time not trying to figure out who had the drug and who didn't. It's a secret; humans love secrets, and a doctor is extremely well-suited to figure this one out.

Your argument here basically questions the whole idea of blinded studies ("Who cares if doctors will figure out which medication is the placebo?", it suggests; "After all, that only matters if doctors are crooked.")

But you're replying to a comment that lays out a scenario in which 8-9 figure clinical trials were ruined by the incidental outcome of reasonable honest doctors accidentally unblinding studies.

I don't mean more disclosure to the doctors on the pills, if that's what you thought, which I'm only assuming because I wasn't attempting to question the validity of clinical trials at all. I was saying given the language the person I was replying to used, it seemed like the doctors were actively trying to figure out what which pills were which, evidenced by the fact that instead of going "dang, we accidentally figured it out and now are susceptible to bias. We should start the trials over right NOW instead of wasting money" They went, lets retest these patients since the outcome isn't coming out like we think it should, something they should know isn't going to fly.

Also not saying specifically that it was malice, but that it's either malice or stupidity, or both.

Also, I have ethical and intellectual standards of doctors doing things that will impact hundreds of thousands of people.

Not sure why you said "Who cares if doctors will figure out which medication is the placebo?" - Since I didn't even insinuate that.

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