'Do No Harm' Means Not Using Drugs of Unproven Efficacy
Abstract
What is the right thing to do in a pandemic? Should scientific rigor be relaxed in the face of a novel illness? What are the risks of allowing unproven drugs to be administered to patients? Is anything better than nothing? In Medicine, the highest level of evidence to prove the efficacy of any treatment is Randomized Control Trials (RCT). When carefully conducted, it rules out errors due to chance, selection bias, observer bias, and other errors that may make us believe that a treatment is effective when in truth it isn’t. Anecdotal evidence from case reports/series is among the lowest level of evidence because they are often biased by the observer. If a clinician believes a drug works, the measurement of clinical improvement will be biased-it is just basic human psychology, the optimism bias. Also, there is often no standardized measurement of improvement in these studies other than the clinician’s subjective assessment (subject to affirmation bias). RCTs have ‘blinding’ for this reason-to introduce objectivity to clinical outcomes measurement. In addition to observer bias, there is also selection bias-the characteristics of patients who make up the case series/reports and who have the so-called good outcomes may be different from those of patients
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