Control?: The Double Blind, Random Gontrol Group Method

I agree with all of that, but when I tried to discuss an actual legitimate DBRCGM, somehow the communication just seems to break down. I am not interested in discussing the conspiracies on this thread because you challenged the legitimacy of the real method itself even without any maliciousness. I am not seeing that the method itself is flawed. Statistics and the media merely allow for deception and thus of course, they go for it as fast as they can. But they always begin with something that when done properly is legitimate. Deceptions don’t work unless there is a lot of truth within them.

Responder Text:

Source: Randomized Controlled Trials (RCTs): A Flawed Gold Standard

Consider this also: should those with profit motive even be conducting studies on their own products? If the DBRCGM was as methodologically sound as most assume, this should not be an issue. See, for instance, Scope and Impact of Financial Conflicts of Interest in Biomedical Research: A Systematic Review, and How Well Do Meta-Analyses Disclose Conflicts of Interests in Underlying Research Studies.

See also:
The Importance of Beta, the Type II Error and Sample Size in the Design and Interpretation of the Randomized Control Trial — Survey of 71 Negative Trials
Reporting of sample size calculation in randomised controlled trials: review
Sample Size Calculations for Randomized Controlled Trials
Statins have no side effects? What our study really found, its fixable flaws, and why trials transparency matters (again).
Why we need observational studies to evaluate the effectiveness of health care.
Limitations of the Randomized Controlled Trial in Evaluating Population-Based Health Interventions
External validity of randomised controlled trials: “To whom do the results of this trial apply?”
Eligibility Criteria of Randomized Controlled Trials Published in High-Impact General Medical Journals: A Systematic Sampling Review
Special Article: A Comparison of Observational Studies and Randomized, Controlled Trials
Comparison of Evidence of Treatment Effects in Randomized and Nonrandomized Studies
Observational Research, Randomised Trials, and Two Views of Medical Science
When are randomised trials unnecessary? Picking signal from noise
JOURNAL OF MEDICAL CASE REPORTS. Case report on trial: Do you, Doctor, swear to tell the truth, the whole truth and nothing but the truth?

Both of these quotes do NOT say that double blind studies are inherently incorrect in any way, at all. They do not say the things that you suggest in your writings; they do not say anything confirming your ill-thought notion that a larger sample size makes the study ‘more complex’ and thus less effective.

These both say that being double-blind is not enough. That the current way of performing studies is incomplete. Not that it is wrong. Not that big sample sizes make the study worse by adding ‘complexity’. Not that ‘randomization contradicts control’. None of your points are here supported by these quotes, and you will have a hard time finding quotes that do because it’s nonsense. Your ‘complexity argument’ is a misunderstanding. Your ‘random assignment contradicts control’ argument is a misunderstanding.

You have an apparent beef with double blind studies. They also have an apparent beef with it. But that’s where the similarity between your ideas and theirs ends. They do not support your arguments.

That’s an amusing link: it suggests LARGER sample sizes. It suggests that the studies that it’s criticising failed because they were using too small sample sizes.

I don’t think you’re in your element here.

Again, you’re attributing points to me I’ve never made. The locution “incorrect” does not apply to my critique. These quotes support my point that DBRGC studies do not account for the extreme complexities of individuals, the subsequent extremely compounded complexities of groups comprised of extremely complex, that these complexes increase exponentially with sample size, and Quetletian/Bayesian fallacies the statistical inferences are allegedly designed to say something meaningful about, even though the parameter are do by fiat. Instead of addressing these points by their merits, which you haven’t even begun to do,you just keep repeating your belief in the validity of your and the DBRCG assumptions.

If you’d been actually reading what I’ve said instead imputing to me things you’ve imagined I’ve implied, you’d know that part of what I’m saying is exactly this. See my posts to Moreno.

This is exactly what I’m saying and I’ve given specific reasons for it which you’ve almost completely ignored. You’ve just restated a few of my comments out of context and repeated ad nauseam, without substance, that this violates your faith in the method. For example:

Again another locution attributed to me I never said.

“Worse” is another mis-attributed locution. I’m saying it creates the illusion of more control than there likely is. “Worse” or “better” are normative judgements for individuals to make through their individual experience with drugs.

When you’ve exhausted your supply of synonymous ways to restate that you disagree with me, please provide a detailed, specific and substantive critique of the content of my views. Other participants in this thread have been able to do so. It would be nice if you would too.

Again, my “beef” is not with double blind studies. They have their usefulness, which you’d know if you’d paid more more careful attention to my comments. My beef is with the strength most people seem to impute to their significance, especially when they’re cited in media like advertisements or the popular press, linked to profit motive, or disconnected from underlying unexamined assumptions about scientific “progress.”

I apologize if I gave the impression that I was citing documents that only support my critique. My intention was to provide a survey of the problems. And there are plenty of references that support my critique. Have you read all of them?

With all due respect, I was wondering the same thing about you not being in your element.

I’ve compiled some basic philosophy of science literature to not only help you understand “my element” but also to help you expand yours. I’d suggest you read through these before you make any more unfounded allegations about my perspective (again, this is a survey–not citations to only support my analysis).

Feyerabend’s “Science and Myth” excerpt from his Against Method

Schick’s introduction to Induction and Confirmation, Hume’s passage about “the problem of induction” in his Enquiry, and Hempel’s, “The Role of Induction…”

Popper’s “The Role of Induction” (pdf pp. 9-13) from Conjectures & Refutations

Duhem’s “Physical Theory and Experiment”

Kuhn’s “Logic of Discovery or Psychology of Research?”

Lakatos’ “Falsification and the Methodology of Research Programmes”

Laudan’s “A Problem Solving Approach to Scientific Progress”

Lipton’s “Inference to the Best Explanation”

Kuhn’s views on observation from his Structures

Hesse’s “Is There an Independent Observation Language?”

Hempel’s “Laws and Their Role in Scientific
Explanation”

Considering the huge backlog of things I already have to read, I don’t really have time to take suggestions on science literature from someone who lacks understanding to the degree that you do.

Choice quotes that show your level, curated by me:

And then to top it off you end with some nonsense about quantum physics!

I will need to be really bored before I’m interested in working my way through your reading list.

Flannel Jesus: I’m genuinely interested in free exchange of ideas, but you seem to be more interested in painting a caricature of me. While you haven’t outright violated your own rule (# 3) of this sub-forum, your last three or four responses come very close, IMHO, to insults. I think you own me an apology. How could you know so much about my “lack of understanding” when you barely even listened to me or hardly tried to hear where I’m coming from.

When you start out by saying that random assignment is a bad thing, and large sample sizes are a bad thing…there’s nothing to think but ‘geeze, this guy really doesn’t get it’.

You later back tracked and said that I misunderstood you, that you don’t think they’re a bad thing. But your language in the OP is pretty clear. It’s clear to me that someone who says “First, the phrase “random assignment” seems contradictory. If “control” is the end, how can randomization be the means? Randomness implies no (or little) controI. The same issue arises with the notion of assignment. If assigning is happening, then the alleged randomness is compromised, if not destroyed, again defeating the purpose of control” doesn’t understand even the basics of why double-blind studies are seen as valuable.

I mean, you completely miss the entire concept of ‘assigning’; just completely. Assigning MUST happen in a study comparing eg a drug to eg a placebo. Some people MUST be assigned one and others assigned the other. You can’t have a trial comparing the two without assigning different people one of the two. What in the world is the alternative? And how does it compromise the randomness? That is the very implementation of the randomness! ‘Randomness’ refers to how people are assigned to treatment or placebo.

In addition to completely misunderstanding what the word ‘assign’ means in this context, you’ve got ‘control’ pretty far off too. The control group in a randomized trial refers to the group that takes the placebo (usually; there are other potential control groups). Randomizing who gets put in the control group does not contradict the end of “control”. You’ve just misunderstood what “control” means.

Your OP was just so so so far off the mark, and backtracking is sorta good in a way when you’re that far off, but the sort of backtracking you need to do is much more extreme than what you have done; instead of just saying ‘no no you misunderstood’, I think it’s really time you just erased everything from the chalkboard, said ‘I’ve got something wrong here’ and start with a clean slate.

You’re not going to apologize, are you? Oh well. I still think I deserve it.

Never said that.

Never said that either.

There are plenty of other things to think. I’m guessing you can’t see that because you’re more interested in caricaturizing my exchanges than understanding their poignancy.

These are questions, not claims. Examining assumptions, clarification, and free idea exchanges are a far cry from “backtracking.” For instance, I used the word “seem” to avoid exactly your misunderstanding.

Your conflating the obvious limits of DBRCG studies with your caricature that I don’t understand the basics. I couldn’t even pose the OP without a basic understanding, and in previous posts I’ve explained how and why my understanding is advanced. You seem annoyed that I don’t share your unexamined assumptions, which apparently has blinded you from the significance of my content.

More substanceless rhetoric. I heard you the first time you said you disagreed, but you’ve yet to exchange an idea with me about it.

Three unexamined assumptions in a row. There’s no “MUSTs” or “cant’s” about it, a reflection of your unwillingness to think creatively about scientific puzzles.

This is precisely the problem. You’re so indoctrinated you can’t imagine alternatives. Are you one of those people who believe science is progressive?

It’s obvious that “assignment” and “randomness” are contradictory notions. What about this don’t you understand?

You’ve bought into the illusion. It’s a common mistake, but forgivable. You don’t need to keep restating the basics. I understand them thoroughly. Familiarize yourself with the “double pendulum” phenomenon and “the butterfly effect.” Individuals are complex systems, groups even more so.

You’ve confused my clarifications and good faith attempts at free exchanges of ideas with “backtracking.” I guess you’re too invested in your misunderstanding of me to see that.

I will engage with the others in this thread who have shown they can refrain from caricature and demonstrated they’re willing to examine assumptions via a free exchange of ideas, but unless you apologize and start acting civil about it, I’m done interacting with you.

That is the same impression that I got.

Perhaps it needed to be worded very differently if there was a different intention.

Re-worded? Absolutely. After all this commotion (including the same post on another philosophy forum) I see that I’ve not explained myself very well at all. I’ve given the impression to you, Flannel Jesus, et al, that I want to throw the DBRCGM baby out with the DBRCGM bath water, which I don’t. I regret that. Please accept my apology.

Why There’s No Cause to Randomize by John Worrall, professor of Philosophy, Logic & Scientific Method at the London School of Economics

  1. What Evidence? In Evidence-Based Medicine by John Worral, LSE Professor of Philosophy, Logic & Scientific Method

-http://bleedingedge.pynchonwiki.com/wiki/index.php?title=Chapter_31, Commentary to Bleeding Edge, p. 341

-Duena Alfosno in Cormac McCarthy’s All the Pretty Horses (pp. 238-9. Everyman: '99. My italics.)

See also: The Crisis of Confidence in Medical Research by Allen Frances, Professor Emeritus, Duke University (he was also the DSM-IV Task Force Chair and famously also said, “There is no definition of a mental disorder. It’s bullshit. I mean, you just can’t define it” [wired.com/2010/12/ff_dsmv/]).

Listen to philosopher Nigel Warburton interview John Worrall, professor of philosophy of science at the London School of Economics, on RTCs and Evidence-Based Medicine at Philosophy Bites.

Worrall, Philosophy Bites

Though the problem here is not double blind tests, but more on the ontological level and in terms of cause, effect, etc.

True, but too much has been made of the correlations versus causes distinction (although it still has its uses). Correlations are probabilistic indicators of causality (positive correlations) or non-causality (negative correlations). In other words, causality and correlation are not mutually exclusive.

I also disagree with Frances that all anecdotal evidence is untrustworthy. Indeed, most studies are designed to answer questions that arise from anecdotal observations; anecdotes are the incubators for research questions and as such are a necessary part of the investigational process.

The link to the article by John Worral, LSE Professor of Philosophy, Logic & Scientific Method titled “What Evidence? In Evidence-Based Medicine” in my previous post in this thread is now wrongly directing to a cocaine article. This will take you to right the right place: What Evidence? In Evidence-Based Medicine.
This is especially important to my illusion of control point. As Worral puts it:

Dr. H. Gilbert Welch–physician, renowned epidemiologist, professor at Dartmouth Medical School, nationally recognized expert on the effects of medical testing and author of the highly acclaimed book Overdiagnosed: Making People Sick in the Pursuit of Health (Beacon, 2012)–is a big fan of the DBRCGM. Yet in his latest book Less Medicine, More Health: 7 Assumptions That Drive Too Much Medical Care (Beacon, 2015), he admits it has great limitations (pp. 46-8).

First he cites what he calls a “wonderful parody of evidence based medicine” from the British Medical Journal titled, “Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials” (summary here; full report here). Then he says: