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Eleftherios Gkioulekas's avatar

Observational studies can be quite appropriate for treatments using repurposed drugs with acceptable safety. The reason is because one is trying to distinguish between neutral vs positive effect; negative effect is already ruled out knowing the safety profile of the medicines, how they work, and how the disease works. This is in part why, for example, an observational study is sufficient to argue that parachutes reduce mortality for people that jump out of airplanes. For something new however, e.g. a new vaccine, a randomized controlled trial should be required, because the problem there is to distinguish between three possibilities: (a) negative effect; (b) neutral effect; (c) positive effect. There, one needs an unbiased measurement of the effect to rule out the possibility that it is negative.

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Eleftherios Gkioulekas's avatar

One problem in academia is that the smartest people end up in the hard sciences, so there are not enough of them left to go into epidemiology. The other problem is that even without direct Pharma funding, academics are funded by government grants, and Big Pharma buys the government and the media that control the political narratives. Just as academics are under an academic freedom framework (which works well, to some extent), we need a similar framework to protect the patient-doctor relationship. As one example, I don't understand why anyone should even entertain investigating any complaints against doctors not initiated by the patient (or next of kin).

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