• A lot of ignorance is worse than a little knowledge

    Timothy Wilt and Hashim Ahmed published a prostate cancer screening and management clinical review in BMJ. It’s a good resource. This passage caught my attention:

    Comparative effectiveness remains controversial, partly because few randomized treatment trials with mortality outcomes (only one in the PSA era) have been completed. Trials have been difficult to complete owing to the large size and long term follow-up needed, as well as patients’ and clinicians’ reluctance to participate.

    Predictably, they call for more research. No argument there. Somewhat disappointingly, they do not consider the possibility of very large scale observational studies that exploit practice pattern variation as an exogenous source of randomness. I understand well why such an approach may not be on their radar, and it does have limitations, as do RCTs.

    However, prostate cancer screening and treatment is far from the only area of medicine for which more research would be helpful. Indeed, there is more we should study then we’ll ever have funding and time to study with RCT methods. Consequently, if we demand RCTs first and for all things, we are condemning ourselves to a future with insufficient evidence on most things. Less expensive, yet high quality observational studies could fill the void.

    Perhaps a little knowledge is a dangerous thing. In my view, a lot of ignorance is worse.


    • This is the potential hazard of evidence based medicine (versus science based medicine, for instance). Some things aren’t worth studying (or doing) because they can’t work based on the science as we know it, other things can’t be really be subjected to RCT’s. You can make really good decisions without RCT’s. You can also make awful decisions with them.