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So does this mean Ivermectin was actually great, and all the critics were Ivermectinophobes? Or do we, in fact, have some ways to judge the quality of studies, and know for a fact that the absence of certain design features tends to mean a study's finding will tend to be overturned, if done properly?
We will never know either way. One side is claiming ivermectin cures cancer and homosexuality and the other is claiming it has a high risk of causing death. Neither is willing to tell the truth.
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Medicine is hard, and answers to important medical questions can't fit in the length of a tweet. I have a phd in machine learning, so I'm confident I could form an opinion on your questions if I tried really hard and read a bunch of papers and thought about the problem for a week. But I don't care to do that, and so at some point I have to trust other people's judgements.
Part of the parachute study's point is that RCTs are not enough! And you are placing too much faith in RCTs! It's very easy to design a RCT that "looks good from the outside" but has a fatal flaw that makes it not applicable to the real world. In the parachute example, the fatal flaw is that the plane was grounded the whole time. Downthread, people are pointing out a bunch of fatal flaws in hypothetical RCTs for gender transition that would undermine any possible conclusion.
No matter what the methods are of an experiment, you can't get around having to sit down carefully and examine all of the assumptions.
Well, we might run into a problem here, because I don't care much for credentials, but I respect a sincerely held belief. If you don't really want to put your name on the argument for puberty blockers, just poke holes in the arguments against them (but never, ever, for them), I don't know how far we're gonna get, but let's give it a go.
Right, but are you going to tell me that the absence of randomization in controls is going to make the exact same study better? Like, I get that RCT might not be the be-all end-all, or that in some context might not be practically achievable, but you can't beat down any and all skepticism with "the science is settled, chud" type arguments (which is exactly what was happening in the case of transgender care for many years, even if you weren't doing it personally), and retreat to "ho hum, it's so nuanced" when people point out the poor quality of your studies.
I keep linking to that old blogpost about prescribing Lupron to autists, because I never got a good answer for it. Somehow it was clear as day that it's quack medicine back in 2006, and only hardcore libertarians ever dreamt of arguing that maybe we should let people try it if they want, but now doctors are prescribing the same drug to the children of often unwilling parents, with absolutely no evidence (by their own admission), and we're supposed to just roll with it?
I'm happy to, and I believe that if you do that, the entire edifice falls apart. Not just puberty blockers, but the entire concept of "gender dysphoria" as a diagnosis.
All I'm trying to say is that your original post overemphasized the importance of RCTs in medicine. I'm not trying to make any claim about gender dysphoria or its treatment.
You are absolutely correct! But parachutes have been proven to work in practice, while everything about gender affirming surgery is left to the future, a la "they would killed themselves otherwise".
If Junior says he's Napoleon, he is clearly in need of help. But if he says he's Napoleonette, he's stunning and brave. Can he/she/they buy a pack of cigarettes?
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