RIP, Paul Meier

Most of you have likely never heard of Paul Meier, who died last week, but he’s arguably made more of an impact on modern medical research than any other person. He’s the guy who sort of forced us all to use randomized controlled trials:

As early as the mid-1950s, Dr. Meier was one of the first and most vocal proponents of what is called “randomization.”

Under the protocol, researchers randomly assign one group of patients to receive an experimental treatment and another to receive the standard treatment. In that way, the researchers try to avoid unintentionally skewing the results by choosing, for example, the healthier or younger patients to receive the new treatment.

If the number of subjects is large enough, the two groups will be the same in every respect except the treatment they receive. Such randomized controlled trials are considered the most rigorous way to conduct a study and the best way to gather convincing evidence of a treatment’s effects.

Before randomization, the science of clinical trials was imprecise. Researchers, for example, would give a new treatment to patients who they thought might benefit and compare the outcomes to those of previous patients who were not treated, a method that could introduce serious bias.

These days you can’t get a drug approved without a randomized controlled trial, so it’s hard to imagine that just decades ago, someone had to argue they were necessary. But they are. RCTs are pretty much the only way to prove causality (that something causes something else instead of just being associated with it). RCTs are also the best way to overcome hidden biases and the placebo effect.

Even so, I’m still confronted by people who “know” things are true even without proper research. Dr. Meier saw this his whole career:

Researchers were not always attuned to Dr. Meier’s advocacy. “When I said ‘randomize’ in breast cancer trials,” he recalled in a 2004 interview for Clinical Trials, the publication of the Society for Clinical Trials, “I was looked at with amazement by my medical colleagues: ‘Randomize? We know that this treatment is better than that one.’ I said, ‘Not really!’ ”

We’re still not overcoming that inherent bias in plenty of areas, breast cancer included.

If the RCT wasn’t enough, Paul Meier was also half of the team that created the Kaplan-Meier curve, which is pretty much the gold standard in determining survival. If you’ve ever heard of 5- or 10-year survival for something, thank Paul Meier for that, too.

He was 87, and a statistician. He was relatively unknown outside of scientific circles. That’s a shame. The world owes him a great deal.

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