KEEPING HEALTH SIMPLE: Chapter 20- RCT vs. Epidemiological Studies, Case Studies


The randomized control trial, or RCT is heralded in modern science as the “gold standard” of research. The theory is that eliminating as many variables as possible is the way to find the most accurate information. The RCT has at least two groups- a control group and an experimental group. The control group does not receive the treatment and the experimental group does. At the end of the trial the results are compared. The participants are a very narrow sample of the population, as narrow as possible. For example, a group of 100 men between ages 40-45 with similar health histories. The idea is that a group of people that are very similar to one another will give an accurate picture of the effect of whatever is being studied.
In comparison, the epidemiological study is considered less reliable because it does not have a control group. This type of study does not necessarily eliminate people based on age, health history, etc. Instead of trying to eliminate as many variables as possible, it accepts all variables and focuses on the thing being tested, whether it is a drug, food, or form of treatment.
Case studies are ranked as one of the lowest forms of scientific data. A case study is a write-up of one health outcome, for example, how a child diagnosed with ADHD underwent chiropractic care improved their ability to focus. The scientific community views this as “low-level” because it is only one person and according to conventional wisdom, it could be a fluke. But what about 5 case studies that observe similar results? What about 10? 20? 50? At what point do you recognize the value in this observation?
Another question I have-which type of study more accurately accounts for the human experience? Would you rather take a drug that was tested on a very small slice of the human race or would you prefer that a wide variety of the population were tested? Which do you imagine would offer you more protection?
The human race is full of diversity, and people will react differently to treatments. Instead of trying to eliminate variables, why not embrace them? We should be accounting for the variety of existence within our race when we go to study it. Just think of all the factors that can never be controlled.
Going back to our example, consider a group of men 40-45 with similar health histories. We put them in a group that we call “similar” but what about their diet? That alone could be one of the most important factors in how their bodies differ from a physiological perspective. Did you know there are 10,000 different chemical compounds in an apple? What about their sleeping patterns, love life, work situation, etc.? All of these are part of the human experience and it goes to show that eliminating variables is a false premise. Impossible to truly achieve.
Instead why don’t we flip the hierarchy of reliability, placing a volume of case studies at the top and RCT’s at the bottom? This more accurately reflects the human experience, in my opinion. Just one more thing-if drugs are approved via RCT, and that is the gold standard in research, how is it that drugs end up killing people and having to be recalled? If RCT’s were truly reliable this would not occur.

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