Medicine, Engineering, and Randomized Control Trials
Medicine, Engineering, and Randomized Control Trials
An Uneducated Layman Explores
Over the past few years of the current disaster, you've probably heard the term "randomized control trial" (RCT) slung around like candy - often from people who have never designed, performed, or participated in an RCT. I have been in two, and didn't even realize it until 2023 - clinical trials, a decade apart. One for a drug I don't recall, and the other based out of Mt. Sinai for a live attenuated intranasal vaccine to hopefully prevent COVID-19 infections. I've never had COVID-19 as a pre-requisite for this study and haven't had it since - so I remain optimistic that we will end this pandemic in our lifetimes.
I joined this COVID-19 vaccine randomized control trial for the good of the nation, the world, and for some funny money to import a sickass katana. To summarize, these hard-working scientists mixed parts of a rare bird virus with parts of SARS-CoV-2 and shot it up my nose, then sent over a nurse to my apartment regularly to suck out 20 vials of blood and watch me spit into a cup for 20 minutes, to record how effective this new vaccine was. As such, this clearly makes me an expert on all things RCT and vaccine development - I mean, I have a very cool katana now, so who the hell are you to disagree with me? Much more than most of the people who spam "RCT" on Twitter.com all day or written about them for the rightoid libertarian intellectual toilet that is the "Brownstone Institute." It's poop, right in the name!
So just what is a Randomized Control Trial, exactly? An RCT is primarily used in drug research and development. An example is grabbing a few dozen 20-30 something healthy men, giving half of them this new drug, giving the other half a placebo as part of a control group, and recording the effects. This is a very serious and necessary practice when developing new medicines to help save lives, treat illness, and improve people's quality of life. Nobody is debuting the ethics or efficacy of RCTs in the practice of medicine - in developing COVID-19 vaccines, many RCTs were performed to ensure they were safe and effective in preventing deaths. This article is not about debunking tired and moronic anti-vax arguments, but many of them can quickly be put to rest with simple, surface-level research.
Unfortunately, many wannabe-celebrities and dedicated anti-vax crusaders with a medicine background like Vinay Prasad of UCSF, Kevin Bass of Texas Tech, Alasdair Munro who was profiled here, Shira Doron who was covered here, Andrew Bostom, John Mandrola, and uneducated dorks like feral abuser Mark Changizi, Republican thinktank dipshit Phil Kerpen, Manhattan art gallery pervert Eli Klein, techbro Alex Rampell, and many others have decided to cross over from medicine into the realm of engineering and demand Randomized Control Trials in a manner that is wholly unethical, inappropriate, and quite frankly? Very shameful.
Imagine, if you will: a sick person infectious with SARS-CoV-2 walks into a hospital seeking treatment. They begin exhaling the virus into the air via aerosols. Now, which scientific field is responsible for protecting the very vulnerable patients, doctors, nurses, and others already in said hospital from this deadly and disabling virus that has killed and crippled countless millions, worldwide?
Is it the responsibility of:
A) The field of medicine - vaccination, treatment, and managing the illness after it has entered the body?
B) The field of engineering - mitigating and removing the virus before it can enter the body of a patient, doctor, nurse, or any person in general?
Hopefully obvious is that this is a trick question, as the answer is actually: C) All of the above.
Engineers can deploy ventilation and filtration to remove the virus from the circulating air, as well as deploy PPE such as N95 respirators in order to prevent people from being infected, and infecting others, with a deadly and disabling virus. Now, we can't prevent every infection - but we should at least try.
When this fails, we have medicine - vaccination, treatment, and whatever else as I'm not a doctor and I refuse to pretend I'm an expert in any of these matters - I come from an advertising background and make pretty pictures on the computer for a living. Before that, I grew up on a small, remote cattle farm and herded 700lbs+ steers, as well as fly fishing in rivers and hiking up mountains, surrounded by nature.
Just like a bear, the SARS-CoV-2 virus is a part of nature, which must be respected and understood. Not simply shrugged off, beating your chest and hollering like a maniac in a vapid performance for others. It’s critical to understand the differences in medicine and engineering and how we can employ both to protect the public’s health.
As a grown adult with a developed mind, I can practice curiosity, humility, and a willingness to learn from actual experts within these highly technical fields. What should be obvious to any uneducated layman is that if experts within the engineering and medicine fields work together, as empowered by mandates, funding, and resources from governing bodies, then we can prevent future harms caused by the ongoing global SARS-CoV-2 pandemic. There is still an airborne, socially transmitted virus causing horrible disease and long-term harms, unfortunately.
A great example of a leader from the engineering world is Joey Fox, an HVAC engineer who writes for www.itsairborne.com and has provided free & endless wisdom about deploying engineering solutions to prevent SARS-CoV-2 infections. You can follow him at @joeyfox85 via Twitter.com.
A great example of a leader from the medicine world is Dr. Satoshi Akima, a frontline doctor from Australia who is a hero and role model that should frankly be a celebrity on the level of Leonardo DiCaprio for his dedication to providing practical wisdom to the public, for free - and frequently explained the inappropriateness of RCTs for PPE. You can follow him at @ToshiAkima via Twitter.
As a young boy, one fantasizes about being a wandering ronin, or a noble knight; taking up the sword to defend the innocent from harm, whether it's wandering bandits, evil empires, or horrible monsters. To be strong and defend others from harm. And hey, maybe you'll get a kiss from a pretty lady for your troubles! How exciting. But to do so, you have to learn, and then practice. You have to be humble and grounded in empathy for others. Life isn't a videogame with cheat codes, sadly.
It's free and easy to tweet about the need for RCTs when it comes to COVID-19 prevention. UCSF’s Vinay Prasad and the UK’s Alasdair Munro have made an entire social media grift out of it.
It's much harder to actually show up and let a nurse put a weird and unknown substance in your body. To lie in bed alone, shivering and sweating in agony, unsure just what is happening to you. To have over a dozen vials of blood drawn out of you in regular intervals, feeling loopy and humiliated as your body is drained of its essence. There is no joy in accomplishment without fear.
But for the cultural construction that is "real men," like I was raised to become, "the action is the juice."
A great example of what this means is explained in a post by fellow RCT enjoyer, world-renowned SARS-CoV-2 author of “We Want Them Infected,” and COVID-19 frontline veteran Dr. Jonathan Howard, in which he goes out of his way to explain to a medical student how inappropriate it would have been to perform a randomized control trial for hospital visitation policies as far back as the summer of 2020 - when the pandemic of a new and unknown virus was raging worldwide.
Howard's piece is an excellent article that will teach you a lot about the complexities of randomized control trials, much more than any of its most vocal supports would tell you - my only criticism of my dear friend Dr. Howard, is that he slightly misses the point of the "RCT" memeification project. It's not some insightful, intellectual process to be explored, but instead a blunt object. These RCT fetishists will never design, perform, or participate in an actual randomized control trial - but they'll never stop screaming about them because it's a method to confuse and concern troll the general, uneducated public into throwing their own health away as part of a larger right-wing eugenicist agenda against the very existence of public health.
Growing up on the farm, there's a lot of hard work to be done. Mending barbed wire fences, fending off bears & coyotes, building greenhouses, shoveling manure for fertilizer, etc. - it's easy to stand on the edge of the job site and, for lack of a better word, bitch. It's a lot harder to actually pick up the tools and get the work done - so we can all enjoy the bountiful harvest of T-bone steaks, hand-grown potatoes, and celebrate our accomplishments in fending off hunger for another season; to not fear where your next meal comes from.
The engineering field and the medicine field need to work together to help our global & national families survive this ongoing disaster - it's the honorable and noble thing to do. The do-nothing naysayers who want to stand on the edge and holler about how everyone else needs to drop everything and do RCTs instead of saving lives? Will go down in history as the useless eaters who wanted to sit at the table and enjoy a harvest they wasted every waking moment trying to sabotage.
Life is about learning, working, and loving. The histories that follow long after we die will record what we did during a global crisis such as the SARS-CoV-2 pandemic - what do you seek to be remembered for after you're gone?
Someone who showed up to help save lives, or some useless loudmouthed jackass who sat in a fake podcast studio and did nothing but sabotage the health and hard work of those with actual real-world responsibilities?
Excellent article. Thank you. Prasad and his ilk will never get it. Both Mr. Fox and Dr. Akima are magnificent, and are examples of those in their fields willing to work with the other fields. We need all hands on deck to get out of this pandemic, but must cooperate and help each other. The Brownstone, Stanford, USF and Ivy League medical mafias don’t understand this and likely never will.