Thread by @angryhacademic

If you have a trial for a heterogeneous condition like #MECFS, then looking at average effects is no longer a good option to determine effectiveness.

If half improve and half get worse, we determine the intervention ineffective.

#academict

Instead we should explore *why* those who responded did respond and vice versa.

For the non responders we should then move them on to another intervention

We also need to consider poly-interventions to address multiple pathologies

This is a whole different way of trialling drug efficacy than we do now.

Folk will rightly point out the flaws in this such as the bias it introduces but fail to understand the bias current trials introduce

We can never have a perfect trial.

Heterogeneous diseases cannot be studied in the same paradigm as homogeneous diseases

It is important to understand that X works in some but not others. This gives patients an option to try and guidelines to follow

We will never get answers for such diseases all the time we are hunting for a single biomarker and single treatment for all

Nothing is simple in these diseases, so myopic thinking wont be the answer

(To be clear: folks studying a single pathway are still needed. We need highly specialised experts. But we also need experts who can put all those bits together to create a bigger picture and provide individualised research and care)

Me and @Naomi_D_Harvey have been raging about this today 🤣

Also dunno what is up with twitter hashtag recently, should be #academictwitter in tweet 1