A big thanks to co-authors, @sameo416.bsky.social@juliamwright.bsky.social@jmcrookston.bsky.social@dfisman.bsky.social and Corinna Nielson.

They don't even work for doctors. Just stepping stones for a few political types, on their way to bigger and better things - while the actual health care workers they sold out get long COVID and burn out trying to hold healthcare together. Integrity requires this: www.bma.org.uk/advice-and-s...

IMO the biggest problem that medicine faces is that it consistently picks the worst human beings in the profession for leadership roles. The second biggest is culture, and the collusion that enables the harm those leaders do. Cheers to those fighting back! www.tandfonline.com/doi/full/10....

Like a hammer, RCTs can be effective tools under the right circumstances. But not everything is a nail. 🧵

So all a trial that finds otherwise at the community level can tell us is that the team running the trial did not choose and effectively communicate appropriate protocols for their use. There is no magical property of RCTs that can change that fact.

With adequate training, workers in a broad range of industries know from experience that they are quite capable of wearing their PPE consistently. And a well-fitting N95 can stop transmission - at this point all but the most fanatical airborne-deniers have accepted that fact.

…that even a poorly designed and executed RCT outweighs any amount of "outside" evidence. This frees the advocate from the need to understand and address expertise and findings from other fields, and allows them to stake their claim to the resulting "terra nullius".

This brings us back to the unfortunate conflation of EBM (a useful shortcut under the right circumstances) and science. The mistaken belief that RCTs magically have universally greater evidentiary value than all other approaches leads to the erroneous-but-convenient assumption…

…in the success of the intervention, or that is not completely transparent and free from outside interference (such as a publicity campaign arguing that the drug is ineffective, and trial participants should not take their assigned medications).

A drug company could easily generate a trial in which their competitor's product was not effective - but it wouldn't mean very much. The same is true for a trial employing a protocol that wouldn't be accepted by experts with a clear interest…