With the magic term "experimental", we have become prisoners of our own rhetoric. Given the direction in which we are being dragged by today's mega-trials, we better extricate ourselves before we get into bigger trouble. -- see attachment.The clinician, unlike the basic scientist, has to act even when knowledge is insufficient for a fuller informed decision. A "consensus" view under these circumstances can be achieved in only three ways: by compromise, by selection of an expert panel whose views conform, or by use of language that obscures differences.Most clinicians and researchers, including trialists, are over-confident that by remaining below the radar of truth, they can get away with almost anything with play of words, Orwellian double-talk, and triple-thinking, obfuscation and nihilism, and throwing the issue to to further studies in the future, all the while NEVER acknowledging that they are or were and will remain forever in error. Ego and argument go together, but remain divorced from scientific truth. -- see attachments. Qualities that are perpetually in short supply in clinical trials include: Motivation, Judgment, Rapport, Ethics, Pragmatism, and Courage to acknowledge Limitations or Errors in the conceptualization and execution of the trial. -- see attachment. Halpern summarized the goals of critical thinking as: to recognize propaganda;to analyse hidden assumptions in arguments;to recognize deliberate deception;to assess credibility of information, andto work through problems/decisions in the best way.Halpern attributed to critical thinkers the characteristics of flexibility, persistence and a willingness to plan, self-correct, be aware of their own thought processes (metacognitive monitoring) and be consensus-seeking. --Halpern DF. Thought and Knowledge: an Introduction to Critical Thinking. 3rd edn. Mahwah, New Jersey: Lawrence Erlbaum Associates, 1996.The trial becomes more important than the patient -- this is the crux of the matter when the SNAFU hits the trialists even without their knowing or appreciating it. Straight quote from my book: Adaptive Mechanisms in Migraine. Breaking The Migraine Code. Nova Science Publishers, Inc., New York, 2009: "Contemporary migraine research stands where cardiovascular medicine once stood before the discovery of the atheromatous plaque."(Gupta, 2006, BMJ). Vagal stimulation for managing migraine is like decorating the penthouse of a 200-storeyed skyscraper without any foundation ever laid, i.e., a castle-in-the-air, with the solidity provided by pure wind (George Orwell). For the fashion twitterati in migraine research, what could be more natural than to jump on the bandwagon, and to pursue VAGUS stimulation by the device/gadget Cefaly as a management strategy.The vagabond cranial nerve has lived up to its reputation.Do we recall the "Migra-lief" apparatus of a bygone era? Or Cryohelmet or Cryoscarf? -- no side-effects, at all. AMAZING, isn't it?It is the Wild West all over again, at least as far as migraine research is concerned, coupled to an enlarging vocabulary, the opiate of research.
