The tsunami of RCT in migraine has plateaued, if not subsided, after the CGRT-monoclonal antibody bandwagon has completed its role by early 2019 in the ongoing theatre of migraine research.
The RCT rests heavily , if not completely, on the mathematical power of statistics. The negative role of statistics in medical research is just becoming apparent (see attached file), although I have been highlighting the same since 3 decades.
Now, the role and the biological value of the RCT will begin to be debated, its limitations will be appreciated, and its role in positive and negative results will clear the desk of much clutter.
The category of the absurd, whose demarcation has been eliminated through the careful orchestration of the RCT, sits right in front-and- middle of the laptop / desktop of every researcher in medicine.
Vinod,
You ask a retorical question for you know, I know, everyone knows the answer is YES.
I have followed many threads on this platform discussing statistic, p-values and its value in medical research.
You-Tube the Dance of the P-value. It is a great illustration of the folly in hanging one’s hat on a p-value. I do not agree with the others that want to drop “significance“ to 0.01, for that move doesn’t improve research.
Is it “significance testing “ that is the problem or is it the lack of statistical understanding? Or is it the academic fraud perpetrated by those that understand that “4 of every 3 people don’t understand statistics “?
In medicine, clinical significance should drive the use of RCTs. Effect size, cost/benefit and risk/benefit.
The inherent problem with “Big Data” solutions is the validity of the raw data. My experience with large data sets (limited as it is) is that the data can not always be trusted. I would hate to make policy changes based on faulty data. Until we fix the input to ensure reliability and validity we shouldn’t rely upon it as our future for medical advancement.
IMHO,
Christopher
Chris,
If what everyone knows is invariably or more often than not, correct, research and discovery become pointless. It is when the herd is disproved that a scientific advance occurs.
Vinod
AF Ablation Misses Primary Endpoint to Reduce Morbidity and Mortality
Mark S. Link, MD reviewing Packer DL et al. JAMA 2019 Apr 2 Mark DB et al. JAMA 2019 Apr 2 Albert CM and Bhatt DL. JAMA 2019 Apr 2
ALL NULL HYPOTHESESE CARRIED OUT TO SUCCESS are NEGATIVE RCTS.
April 05, 2019
Null Hypothesis Open Access
INTREPAD
A randomized trial of naproxen to slow progress of presymptomatic Alzheimer disease
Pierre-François Meyer, Jennifer Tremblay-Mercier, Jeannie Leoutsakos, Cécile Madjar, Marie-Élyse Lafaille-Maignan, Melissa Savard, View ORCID ProfilePedro Rosa-Neto, Judes Poirier, Pierre Etienne, John Breitner, for the PREVENT-AD research group First published April 5, 2019, DOI: https://doi.org/10.1212/WNL.0000000000007232
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