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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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    1. 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.
      4 replies 32 retweets 109 likes
      Show this thread
    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
      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/

      6:14 AM - 30 Apr 2020
      • 2 Retweets
      • 39 Likes
      • Tyler Marshall, PhD MPH Jeremy Kyle Garcia Ann McCann David de Andrade Nunes RegulatoryDad🇨🇦 Cactuar512 Dr. The unified self is just my MacGuffin. Annette Neary 🇮🇪 Stormageddon, Dark Lord of All
      2 replies 2 retweets 39 likes
        1. New conversation
        2. 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
        3. 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
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        4. 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
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        5. 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
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        6. 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
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        7. 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
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        8. End of conversation
        1. John Mashey‏ @JohnMashey 30 Apr 2020
          Replying to @gorskon

          Agreed. For instance, no one will ever do the RCT on 10,000 teenagers, where half are required to smoke and the other half aren't allowed to, and then followed for decades (like the famous Doll & Hill British doctors studies).

          0 replies 0 retweets 0 likes
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