“The study, conducted at ACTG sites across the United States, planned to rapidly enroll approximately 2,000 adults who had laboratory-confirmed infection with SARS-CoV-2…Since its launch in May, however, the study had enrolled only 20 participants, despite efforts by the study sites to enhance recruitment.”
It’s worth listening to people who actually worked on randomized-controlled trials (RCTs) during the pandemic. One researcher said:
I think of what my clinical research team went through to enroll people in that trial, and I thought my nurses were going to die. One of them got covid and got sick. Imagine trying to do that on a daily basis, multiple patients, some of them facing intubation, none of them have their families.
Another said:
There was one day our system had 84 deaths. And then you’re going to ask me to potentially put them on a placebo? It’s just really heart wrenching, talking with families, if your patients are able to communicate — and you’re dealing with all these deaths.
Not surprisingly, graveyards are full of dead RCTs. At the start of the pandemic, a proposed RCT run by the National Institutes of Health of hydroxychloroquine and azithromycin – the most basic RCT imaginable, run by the vaunted NIH- closed in a month after enrolling just 20 patients, or just 1% of their goal. No doubt that study looked great on paper.
To make matters worse, even successful RCTs had a very short shelf-life. Both the virus and the population changed dramatically and constantly. As such, the original vaccine RCTs became historical relics in less than a year.
“In Defense of the Randomized Trial”
It turns out that actually running an RCT, especially one that has lasting value, is a lot harder than merely calling for an RCT, especially during a pandemic.
Not everyone felt this way. In podcasts, Tweets, and editorials, some doctors made RCTs sound pretty easy- “You could have run many cluster RCTs of different masking strategies“. These doctors lamented that other doctors did not do more RCTs and argued that knowledge obtained outside of RCTs was invalid, at least for the benefits, though not the purported harms, of any measure to limit COVID, including vaccines.
Despite their professed love for RCTs, these doctors did nothing to advance actual RCTs. They never worked on an RCT themselves, and although RCTs require a large number of motivated, trusting volunteers, like me, they never even encouraged their audience to enroll in one. Instead of promoting RCTs and trying to instill confidence in researchers who actually recruit people into them, methodolatrists undermined them by spreading fear, uncertainly, and doubt.
Stealing from a pre-pandemic anti-vaccine technique where vaccines were said to be unsafe because the entire vaccine schedule had not been studied via an RCT, pandemic methodolatrists similarly claimed that mitigation measures that had not justified themselves via an RCT were worthless by default. The formula was mind-numbingly simple:
- I don’t like mitigation measure X.
- Mitigation measure X was not studied via an RCT, though if it was studied via an RCT (e.g. pediatric vaccines), that RCT was too small or is now out of date.
- Therefore we should not do mitigation measure X.
This again reveals how the virus was treated fundamentally different from measures to control it. I’ve discussed many times how the risks of each were held to absurdly different standards. Doctors treated rare, usually mild vaccine side-effects, even abnormal lab values after vaccination, as a fate worse than death from COVID, for example, and as morgues overflowed with COVID victims, claimed that measures to contain the virus “can be far worse than anything coronavirus can do.”
At a more fundamental level, doctors had different standards for how knowledge could be obtained in the first place and even what constitutes an action. Any proposed measure to limit COVID was deemed an action whose benefit needed to be proven via an RCT. “It is scientifically and morally wrong to push policies year after year with no credible data they help,” wrote one doctor in an essay titled In Defense of the Randomized Trial that berated other doctors for not doing more RCTs. This doctor boasted that he was “one of the few who called for RCTs“, as if merely calling for RCTs was a genuine achievement.
However, these doctors’ demands for RCTs were applied very selectively, only to the benefits of mitigation measures they opposed. They did not need RCTs to make bold, confident claims that mitigation measures caused harm. While literally all observational studies that supported vaccines and mitigation measures were summarily discarded- “observational data has been used to support vaccines, but is plagued by confounding”- any small observational study that showed a whiff of harm was treated with the utmost gravity. With these studies, even a VAERS dumpster dive was lauded as a “bombshell“.
Similarly, removing mitigation measures wasn’t viewed as taking an action, and so these doctors didn’t demand RCTs to prove it was safe to take them away. They didn’t need RCTs to push policies that spread the virus. Pro-infection doctors didn’t demand RCTs before advocating for unvaccinated children and young adults to contract COVID.
Indeed methodolatrists never demanded RCTs to support their favored pandemic policies. The baseline was conveniently set so they were always right by default, and never had to prove anything. The burden of proof always lay with those who wished to limit the spread of the virus, never with those who wanted to infect young people with it.
Thus it becomes clear, methodolatrists performatively fetishized RCTs not to advance medical research, but rather to sow anger and mistrust about unwanted mitigation measures and the entire concept of public health. Methodolatry converts a study design into an epistemological weapon, as Dr. David Gorski recently explained.
“When you isolate everyone, including all the healthy people, you’re prolonging the problem because you’re preventing population immunity.”
Of course, it wasn’t a secret that some doctors had a vested interest in attacking mitigation measures. They said it was “fantastic news that we have a lot of cases” and that it was “reckless to let children age into a more serious encounter with a disease best dealt with while younger.” Pro-infection doctors didn’t honestly question whether mitigation measures slowed the spread of the virus, they sought to undermine them precisely because they slowed the spread of the virus. As one doctor lamented early in the pandemic:
When you isolate everyone, including all the healthy people, you’re prolonging the problem because you’re preventing population immunity.
Pro-infection doctors knew mitigation measures interfered with their plan to achieve herd immunity in 3-6 months through the mass infection of unvaccinated youth. Not all doctors who “called for” RCTs were pure-of-heart, neutral observers simply pleading for better science and data. Many had an agenda. They wanted them infected.
“I think of what my clinical research team went through to enroll people in that trial, and I thought my nurses were going to die.”
We can all agree RCTs are the gold-standard and more should have been done during the pandemic. However, please reread the quotes from actual researchers that opened this essay. It was not possible to have conducted an RCT for every mitigation measure for every variant and every demographic subgroup. Decisions have to be made in real-time with incomplete evidence, and encouraging people to repeatedly contract a new, mutating virus absolutely is a decision.
Those who recognized these obvious facts are not against RCTs as has been claimed, and doctors who sat on the sidelines doing nothing but saying “RCTs for thee, but not for me“, aren’t really for RCTs, are they?