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gorskon's profile
David Gorski, MD, PhD
David Gorski, MD, PhD
David Gorski, MD, PhD
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@gorskon

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David Gorski, MD, PhDVerified account

@gorskon

Surgeon/scientist promoting science in medicine and exposing quackery. Editor of Science-Based Medicine. My opinions do NOT represent those of my employers.

Michigan, USA
sciencebasedmedicine.org
Joined October 2009

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    David Gorski, MD, PhD‏Verified account @gorskon 30 Apr 2020

    David Gorski, MD, PhD Retweeted AMC Signpost

    This is a common straw man attack, that randomized controlled trials are the only valid form of scientific evidence. Oddly enough, that is EXACTLY what proponents of science-based medicine argue against, just not in the way our friend here thinks. I'll briefly explain. 1/https://twitter.com/AMC_Signpost/status/1255840648898347008 …

    David Gorski, MD, PhD added,

    AMC Signpost @AMC_Signpost
    Replying to @kevin_kehres @jonathanstea and 13 others
    Not even the CAM professional bodies claim Reiki is evidenced. Unsure what the obsession with it is (not just you, it's a recurrent theme). Scepticism is good, with you all the way. Just don't accept RCT data is the only acceptable form of evidence.
    6:14 AM - 30 Apr 2020
    • 32 Retweets
    • 109 Likes
    • The Lord Wolf The Grey Girl (is on semi-hiatus) gmopundit (David Tribe Ph.D.) Vinceremo Mary 😷😭🌶🖤 Curran Ayoub Dangor Brian Avery John Charpentier, Ph.D. Denise Dickeson
    4 replies 32 retweets 109 likes
      1. New conversation
      2. David Gorski, MD, PhD‏Verified account @gorskon 30 Apr 2020

        I've used a term, "methodolatry," to describe the "obscene worship of the double blind RCT as the only valid method of scientific investigation," and some extreme EBM proponents do occasionally exhibit this quality. They are the minority, however. 2/

        1 reply 1 retweet 40 likes
        Show this thread
      3. David Gorski, MD, PhD‏Verified account @gorskon 30 Apr 2020

        We all know that sometimes double blind RCTs can't be done for various reasons. Some RCTs would be unethical; for instance, using a placebo is usually unethical if an effective therapy exists. Sometimes, logistically it's just not possible. 3/

        2 replies 2 retweets 39 likes
        Show this thread
      4. David Gorski, MD, PhD‏Verified account @gorskon 30 Apr 2020

        In these cases, we have to look at different methods that might not be as rigorous as the gold standard RCT and try to come to a conclusion through a confluence of studies. 4/

        1 reply 1 retweet 33 likes
        Show this thread
      5. David Gorski, MD, PhD‏Verified account @gorskon 30 Apr 2020

        In the case of alternative medicine, however, particularly the highly implausible modalities (e.g., reiki, homeopathy), we can look at basic science and assess the likelihood that such therapies can work. That's called the pretest probability. 5/

        1 reply 6 retweets 44 likes
        Show this thread
      6. David Gorski, MD, PhD‏Verified account @gorskon 30 Apr 2020

        For a modality like homeopathy to work, large swaths of well-established science in physics, chemistry, biochemistry, and physiology would have to be not just wrong, but spectacularly wrong. (Note that I leave the tiny possibility open that it could work.) 6/

        1 reply 7 retweets 51 likes
        Show this thread
      7. David Gorski, MD, PhD‏Verified account @gorskon 30 Apr 2020

        Because that's true, we can conclude, using basic science considerations alone, that homeopathy is so incredibly implausible that its pretest probability is, for all practical intents and purposes, indistinguishable from zero. 7/

        1 reply 4 retweets 43 likes
        Show this thread
      8. David Gorski, MD, PhD‏Verified account @gorskon 30 Apr 2020

        Another way to look at it: Basic science considerations alone tell us that homeopathy being effective to treat anything is so improbable as to be functionally indistinguishable from impossible. 8/

        1 reply 6 retweets 55 likes
        Show this thread
      9. David Gorski, MD, PhD‏Verified account @gorskon 30 Apr 2020

        So, it's true. RCTs aren't the *only* valid method of scientific investigation of the efficacy of a treatment. They do, however, remain the gold standard for investigating a treatment with scientific plausibility based on preclinical scientific investigations. 9/9

        2 replies 6 retweets 65 likes
        Show this thread
      10. End of conversation
      1. Tyler Marshall, PhD MPH‏ @tmarshall_phd 30 Apr 2020
        Replying to @gorskon

        Thanks for this thread. I’m about to work on a SR of RCTs today and this was a good brain 🧠 warm up ☕️

        0 replies 0 retweets 5 likes
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      1. Jud_Marc‏ @JudMarc2 30 Apr 2020
        Replying to @gorskon

        And because of that it would likely be found unethical to propose using these in most human trials.

        0 replies 0 retweets 2 likes
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