RCTs ARE the basis of good clinical practice

www.tylervigen.com

Patient

Study designBelieveable RESULTS

RESULTS Generalisable

Population

ISIS 2: aspirin and streptokinase

-2.8% -2.4% -5.2%

ISIS-2: Lancet 1988

Thirty years and millions of unnecessary deaths between the

first trial and the eventual proof of worthwhile treatment benefit

Lancet 2005; 365:1957–59

CRASH-1: steroids in TBIRoberts: Lancet 2005

Thirty years and many thousands of unnecessary deaths between the

first trial and eventual proof of significant harm

This actually happened …..

A decade of uncertainty and between the first trial and eventual

proof of harm

Emphasises the importance in determining longer-term patient-

centred outcomes.

Kavanagh: AJRCCM 2015

Hammond: ESICM 2015

Fifty years of uncertainty about the safety and efficacy of one of the most common

interventions in acute medicine and unequivocal proof of harm.

Thousands of lives saved, millions of dollars saved.

We cannot solve our problems with the same thinking we used when we created them.