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Clinical Trials
We don't need to do a clinical trial of this change because the standard of care is to adopt new ideas without doing clinical trials.
Title text: We don't need to do a clinical trial of this change because the standard of care is to adopt new ideas without doing clinical trials.


Ambox notice.png This explanation may be incomplete or incorrect: Created by MEDICAL PROCEDURE STEP DERF - Please change this comment when editing this page. Do NOT delete this tag too soon.

The comic begins with a simple process for adopting a new idea just by convincing people that it is a good idea. The joke is that this skips the important step of checking whether it actually is a good idea. That correction presumably comes about after ideas are adopted which sounded good but turn out to be harmful. The comic captions the addition of this checking step as "the invention of clinical trials".

The purpose of clinical trials in medicine is to make sure that a new medicine works and doesn't have serious side-effects. One example of the dangers of failing to make sure that it doesn't have serious side effects is thalidomide, which caused a lot of birth defects. In a clinical trial, the effect of a treatment is compared to the effect of a placebo, or an existing treatment, to make sure it has actually has a beneficial effect. (Earlier trials establish that it is even a viable candidate for testing and establishing possible dosages/regimens that can then be carried forward to a treatment (Phase III) trial.)

Before the invention of clinical trials, people generally didn't know, or at least had no way of confirming, whether medicines actually worked. Although many herbs and medicines were effective, others were no better than a placebo, and some medical treatments such as trepanation and bloodletting not only had no benefit but were very likely to be harmful. Those treatments that did work at all were mostly those that had been tried (for whatever reason) and had just happened to be useful, but many others that were tried had neutral or even adverse effects, but had still managed to not be so entirely deadly such that recoveries regardless of (or despite!) such treatments were taken as common-knowledge 'proof' of their efficacy.

Some may, like some of today's treatments, have been gradually discovered to help a particular condition only by noticing beneficial side-effects when consumed for sustenance or for unrelated medical 'guesses'. However, they also remained without the full scientific rigour so long as it remained a 'traditional remedy' with at best an oral tradition across many disparate practitioners, and no consistent effort to formalise or test the falsifiability of any findings.

At the time that this comic was published, the world was in the middle of the COVID-19 pandemic, which made the existence of clinical trials more relevant to the public, who waited eagerly for what sounded like good ideas to get through clinical trials and available to the general public… or fail clinical trials and not do that. During this frustrating wait, many unscientific claims have been made that various drugs or non-drug treatments (such as sunlight) are cures for COVID-19, making it difficult to convince believers to get real treatments. On the other hand, many people were skeptical about COVID-19 vaccines which were made available to the public several months before the clinical trials were finished (they have since been completed and the vaccines fully approved).

The title text is a nice bit of Munroean humor. "Standard of care" refers to the previously accepted practice which a new medicine needs to be compared against. Because the original 3-step "standard of care" in this comic didn't include clinical trials before their adoption, we didn't need to do any testing in order to decide to start using them. If we had had them as the standard of care, then we would have had to perform tests before we added a step and it would have taken longer. This assumes that the process itself is subject to the same scientific rigor as medical treatment; in practice that would be more of a political change that is still not tested.


Ambox notice.png This transcript is incomplete. Please help editing it! Thanks.
1. Come up with new idea
2. Convince people it's good
[Scrawled in red as an afterthought, an arrow inserting it between item 2 and the original item 3]
3. Check whether it works
3. [Now scribbled over and amended to "4."]
New idea is adopted
[Caption below the panel]
The invention of clinical trials

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