Not long ago, a contrarian doctor sought to induce conformity and groupthink in his readers by asking them to take a public, written pledge to refuse further COVID vaccines unless they demonstrated benefit via a randomized-controlled trial (RCT). While I agree that RCTs are the gold-standard for evidence, they are not the only study design by which we can learn about the world, especially during a rapidly advancing and changing pandemic. There have been no RCTs of SARS‑CoV‑2, after all, and encouraging people to contract it repeatedly it is a choice made without evidence of safety.
However, this doctor’s pledge was not meant to advance research. Rather, endless calls for other doctors to do RCTs are made to create fear, uncertainly, and doubt about medical knowledge. I am confident that such mistrust will make people less willing to enroll in actual RCTs.
My recognition that not everything can be studied via a pristine RCT does not mean that I am against RCTs in principle, of course. If I could snap my fingers and will RCTs into existence, I certainly would. In fact, I am such a strong believer in RCTs that I volunteered to be in a COVID-vaccine RCT myself, and I’ve tried to recruit patients into RCTs as well. It’s depressing that many of them close prematurely because they are unable to enroll enough subjects. According to one article titled “Uninformative Research” is the Global Health Crisis You’ve Never Heard Of:
A 2021 study of thousands of COVID-19 drug trials, only 5% of the “study arms” included enough people to generate a statistically valid result.
Any doctor who actually cares about RCTs should find this very disturbing.
I don’t know if I have any sway over my readers. However, to the extent that I can motivate you, I would ask you to take one of these two pledges.
For Medical Professionals
Actually doing an RCT is infinitely more meaningful than merely writing “do an RCT.” As such, I pledge not to sit on the sidelines, only dreaming of RCTs for others to do. Instead, I pledge to work on RCTs and to encourage my patients to enroll in them.
For The General Public
Medical research requires willing volunteers, without whom medicine would never advance. If the opportunity arises, I pledge to volunteer to be in an RCT to further medical knowledge and benefit others.