This is an 26-minute conversation generated by Google’s NoteBookLM, which does a good job in pulling out the key themes from this fascinating and comprehensive article by Toby Rogers:
On the surface, who could object to the idea of “evidence-based medicine”? It sounds so rational, so uncompromised, so objective, so…sciencey.
Well, it turns out that not only was EBM hijacked by commercial interests, but its rise may well have been encouraged by those same interests.
It’s not hard to see how prioritising large-scale randomised clinical trials (which only pharma can afford to run, and over which they have total and exclusive control as regards design, analysis, reporting and publication) over other forms of evidence can benefit such commercial interests.
Some interesting observations about RCTs themselves are also made. Problems include:
Use of surrogate endpoints which have no relevance to patients.
Non-generalisability as the subject cohorts frequently don’t reflect usage in the real world.
Short duration of weeks or months when many drugs are prescribed for years.
Inadequate statistical power to detect safety issues.
Of course, the ultimate evidence-base is assumed to be a meta-analysis of lots of RCTs combined, but it’s obvious to anyone who thinks about this that it’s not possible to fix the above issues by simply combining a lot of studies (preferentially selected by pharma for publication) together into one large analysis.
Final aside: I think this is an excellent article, and I congratulate the author. I find it all the more puzzling, therefore, that he has not been able to see through the “Gain of Function / scary novel virus / bioweapon caused a pandemic” conjuring trick / psy-op.
As far as I can see he fully subscribes to the “we told you, it was a lab-leak all along” trope as expounded by Ridley and others.
Several of us have responded to that here:
Toby feels so strongly about this that he recently said (while misrepresenting our position) “I think you 'no virus, no pandemic' people are nuts” as reported by
here:
Perhaps instead Toby could respond by filling the gaps we have identified in the hypothesis he seems to promote; after all, neither of the authors of the Ridley / van der Merwe paper has yet felt the need to engage.
