Thread by @VPrasadMDMPH

NEW Paper 2022! @vkprasadlab
Once again we analyze the use (& MISUSE) of the parachute analogy in biomedicine

This time we trace citations to the original BMJ 2004 paper & the Yeh remix!

Let me walk you through the paper..
[THREAD]

First, you need to know that a parachute has a huge effect size. Without one, falling from plane, u are sure but dead. With one, deaths are ~1 per 10 million jumps.

Effect size, ARR = 99.999....

AKA amazing. Such a huge effect size, you don't need any trial to know it works!

Second, know that many in medicine love to believe they have something just as good.

My chemotherapy drug -- it's a parachute
A cloth mask to prevent covid -- a parachute
The Impella or Aortic balloon pump - two parachutes
renal artery stenting - parachute

Of course, when people in medicine claim to have a parachute, they often are telling Tall tales

Renal artery stenting has multiple, negative RCTs. hardly seems like a parachute!

Cloth masking didn't work in the Bangladesh RCT, so.. not sure it is a parachute!

Doctors, public health experts or policy makers mostly cry "parachute" to avoid subjecting their favorite intervention to randomized testing.

Enter our study, we trace cites to 2 very famous papers which pushed the parachute analogy-- both half joking

We classified the context with which biomedical authors references these papers, and whether they named a SPECIFIC practice as a parachute.

First, these were the attitudes among biomedical researchers citing these papers. A few conceded RCTs gold standard, but others claimed that observational studies or common sense could supplant RCTs, as with parachutes themselves!

Second, authors analogized 21 specific practices to parachutes, but we found 2/3rds had been tested in RCTs already!

And when tested; 50% were negative trials!

#NotAParachute
Come on that is metaphor ABUSE!

Moreover, in the 5 cases of success, this was the Absolute Risk Reduction

Recall, Parachutes were 99.999...%

7.2 - 44%. That is decent, but it ain't no parachute, get outta here!

We conclude simply, "The parachute analogy appears to be misused and misunderstood in biomedicine."

A final note...

In the decades to come post COVID, the greatest failure will be a failure to generate better data.

It is forgivable to be ignorant in March 2020, but we failed:
Zero randomized trials of school closure
Zero randomized trials business closures

Zero randomized trials on masking in schools
Zero randomized trials on masking kids
Zero randomized trials on masking in USA
Zero randomized trials of 3 vs 6 ft
Zero randomized trials of cohorting

Zero randomized trials of installing HEPA filters
Zero randomized trials of masking, post vaccine
Zero randomized trials testing alternative dosing strategies of vax (post phase 3)
Zero randomized trials of whatever foolishness we are doing on college campuses

Zero randomized trials of asymptomatic testing
Zero randomized trials of quarantine duration
Zero randomized trials of testing for preschool/ school
Zero randomized trials of plexiglass

Zero randomized trials of wearing your mask from the door to table, and table to bathroom, but at no other points during your restaurant experience

Yet many of these things were wrongfully called parachutes by at least some people who should know better

Leaving a pandemic as ignorant as we entered is awful
It is also why all of these issues have become political and not scientific

Science should be ashamed of itself

In 100 years we will look as primitive as the folks who survived the plagues of the middle ages

And...

Abusing the parachute analogy played a small part in the foolishness that we find ourselves in

Read the paper here:
futuremedicine.com/doi/10.2217/ce…