There are hundreds of treatments that are so obviously effective that they don't need a RCT, says Edzard Ernst
Whenever CAM-believers argue against the usefulness of RCTs for determining which treatments work and which not, the ‘PARACHUTE' is not far away [1].
They refer to an excellently funny paper in the BMJ Christmas issue by Smith and Pell [2] where the authors show that using parachutes when falling from the sky is not evidence-based.
The paper concludes: ‘As with many interventions intended to prevent ill health, the effectiveness of parachutes has not been subjected to rigorous evaluation by using randomised controlled trials.
‘Advocates of EBM have criticised the adoption of interventions evaluated by using only observational data. We think that everyone might benefit if the most radical protagonists of EBM organised and participated in a double blind, randomised, placebo controlled, crossover trial of the parachute.'
CAM-fanatics love that quote [1]. They love it because they love straw men in general. Straw men are arguments that no-one really holds but one builds up for the sole purpose of demolishing them. The ultimate aim of this exercise is to look like the victor in an ‘intellectual' dispute.
Who has ever claimed ‘that all therapeutic procedures must be somehow scientifically proven and understood before they can be allowed to be of any benefit to patients'? [1]. Who insists on RCTs in all cases? The answer is simple: nobody.
There are hundreds of treatments that are so obviously effective, that it would be even unethical to conduct an RCT. Feeding a patient via a nasal tube when he is unable to eat, or trying to re-start a heartbeat when it has stopped are two examples which come into my mind - and, of course, using a parachute when falling out of an aeroplane.
So, the frequent references to Smith and Pell by CAM practitioners show, I think, three things.
Firstly, they don't understand the concepts of EBM, secondly, they have also misunderstood the brilliant article about parachutes [1] and thirdly their sense of humor exists only in homeopathic dilution.
Professor Edzard Ernst is professor of complementary medicine at Peninsula Medical School
Professor Edzard Ernst
