Advocates of evidence based medicine have criticised the adoption of interventions evaluated by using only observational data. joined with skydivers to publish “Parachute Use to Prevent Death and Major Trauma When Jumping from Aircraft: Randomized Controlled Trial.” The team enlisted and randomized 23 volunteers.
We think that everyone might benefit if the most radical protagonists of evidence based medicine organised and participated in a double blind, randomised, placebo controlled, crossover trial of the parachute.” Which brings us to the Christmas issue of the , always stocked with unconventional scholarship. Twelve participants wore parachutes while the other 11 donned backpacks that contained no parachutes. The jumpers were assessed shortly after hitting the ground for death or major trauma, and most were reevaluated 30 days later.
Most generally it’s a powerful reminder not to trust headlines.
When it comes to science, you really do have to read the sometimes dense Methods and Results sections.
Otherwise too many dumb RCTs will inform clinical decision making.
Too often studies conclude with something like the following from the "parachute study" just because it's the conclusion from an RCT: "Our findings should give momentary pause to experts who advocate for routine use of parachutes for jumps from aircraft in recreational or military settings."So, an RCT taken out of the total clinical context is more of a lead standard than a gold standard; RCTs can be dumb.
The researchers further note, “A minor caveat to our findings is that the rate of the primary outcome was substantially lower in this study than was anticipated ...
[subjects] could have been at lower risk of death or major trauma because they jumped from an average altitude of 0.6 m [just under 2 feet] on aircraft moving at an average of 0 km/h.” As the reader suspected, the aircraft were parked on the ground.
The researchers also said, “Opponents of evidence-based medicine have frequently argued that no one would perform a randomized trial of parachute use.
We have shown this argument to be flawed, having conclusively shown that it is possible to randomize participants to jumping from an aircraft with versus without parachutes (albeit under limited and specific scenarios).” By the way, no participants actually deployed their parachutes—if you throw around square yards of fabric and feet of strings, somebody could get hurt.