Thread by @StabellBenn

Good piece on "The Pandemic Evidence Failure":
"we cannot just demonstrate medical drugs or devices have a mechanism which should cause the effect that we want - because when we apply them to complex systems, unexpected things happen".

https://twitter.com/apsmunro/status/1551820588095791105

It is a favorite topic of mine. During the pandemic, I suggested numerous cluster-randomized trials that could have been done while we rolled out (or rolled back) some of the population-targeted health interventions @DanishIAS #becurious

My insisting on real-life testing of health interventions - even if there are clear ideas about how they should work - stems from Africa. We observed that vaccines affected all-cause mortality much more than explained from their specific effects. ted.com/talks/christin…

We need to identify the barriers towards testing health interventions in trials. The piece by @apsmunro identifies two: a reluctance to conduct trials once an intervention is implemented, and lack of experience in the public health and medical community.

Also, many people perceive such trials unfair: if it is believed that an intervention is good, why should some be deprived/receive it delayed?
But as shown by eg @VPrasadMDMPH @adamcifu interventions believed to be good, can be useless or even harmful.
press.jhu.edu/books/title/11…

The pandemic added an extra dimension as many interventions were mandated. For this, particularly good evidence is needed.
As we start evaluating the pandemic I hope that one of the key messages will be the need for more real-life testing of interventions in the future.