The problem as I see it is this — NO COMMUNICATION. Doctors who succeed and doctors who don’t succeed are talking past each other without exchanging notes. The truth is out there, we must find out what it is.
The problem is lack of research. Research funding goes to things that can be patented. If something is natural, it’s unlikely to increase sells for one specific company, so people don’t research natural things.
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RE: The problem is lack of research. Research funding goes to things that can be patented. If something is natural, it’s unlikely to increase sells for one specific company, so people don’t research natural things.
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Everyone agrees that Random Controlled Tests (RCTs) represent a high standard. In an RCT, patients are divided into two groups. One gets the drug under investigation; the other gets a placebo. The study is double-blind in that neither patient nor doctor knows who is getting which, so expectations cannot influence the outcome. If the results for the groups are significantly different, one can be confident that the drug is beneficial. And if side-effects in the treated group are rare, one can also be confident of safety.
But total reliance on RCTs runs into immediate problems. They are expensive, so their number is inherently limited. In particular, no private company will fund one for any off-patent drug, which is why Big Pharma is opposed to research on ivermectin. No one owns it.
Performing research on off-patent drugs should be a major task of government health agencies, but these appear to be under the thumb of Big Pharma and not interested.
Recruiting for an RCT can be a big problem. Identifying relevant population sub-groups is difficult, and the more possible sub-groups that exist, the more expensive the trial and the more difficult its design and interpretation.
Dosages must be determined, as must timing and possible interaction with other drugs. That RCTs adequately identify side-effects, especially for sensitive groups such as the elderly, is disputed.
In the real world, RCTs are one component of a complex system for collecting knowledge. A lot of preliminary works is necessary before one gets to the point of doing an RCT, and that work in itself produces evidence of varying strength.
Lab workers have looked at mechanisms of action and formulated and tested various hypotheses. As clinical research and experience accumulate, lab and clinical work cross-fertilize.
However, RCTs are NOT the only way to determine whether a drug works on not for a disease.
Clinicians have also observed diseases, formed ideas about what might work, consulted colleagues, and tried things out. To a high degree, medical progress depends on crowd-sourcing by doctors.
Once the FDA approves a drug for any purpose (which provides good information about safety), any M.D. can prescribe it for any other purpose. Then they go to medical meetings and compare notes. Repeated clinical experience, especially from multiple doctors, and subjected to devil’s advocate review, can be as good as an RCT.
A patient also serves as his own control group. If a doctor gives a drug to a patient who has a longstanding condition and it immediately clears up, the doctor thinks, “Hmm.” This is an anecdote. If it happens with a second patient, the doctor thinks, “Wow.” A third time and we are getting into the realm of “studies.”
Yet another source of knowledge is epidemiology. If a disease is prevalent in a population, a drug is distributed, and the disease recedes, this is evidence, especially if the disease remains in comparable populations that did not receive it.
Some of the best evidence of the efficacy of ivermectin comes from several states in India and some cities in Mexico, which pass it out freely.
In my view, To reduce this complex system of producing knowledge down to a reliance on “nothing but RCTs” is not just limiting; it can be fatal.