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2530: Clinical Trials

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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.

Explanation[edit]

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.
If you can address this issue, please edit the page! Thanks.

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 to a placebo to make sure it has a benefit.

Before the invention of clinical trials, people generally didn't know, or at least had no way of confirming, whether medicines actually worked. Although a some herbs and medicines were stumbled upon, most medicine was no better than a placebo. A lot of medical treatments such as trepanation and bloodletting not only had no benefit, but were very likely to be harmful.

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.

The title text is a nice bit of Monroean humor -- because we didn't have clinical trials as part of the "standard of care" before their adoption, we didn't need to do testing before we started using them. If we had had them as the standard of care, then we would have had to perform tests before we switched over (in concept; in practice of course that kind of political change is still not tested) and it would have taken longer.

Transcript[edit]

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 handwriting, as an afterthought, an arrow indicating it is 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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Discussion

Is this comic in reaction to some specific recent event? It seems like it might be related to vaccine trials, given the pandemic the world has been dealing with for the last 2 years... if so, it then seems to be a condemnation... am I reading too much into this? Ericfromabeno (talk) 21:49, 18 October 2021 (UTC)

I would say this in relation to the mutiple treatments for Covid19 some of which have great clinical evaluation, others less so. I'll make a first draft Kev (talk) 21:53, 18 October 2021 (UTC)

Note that a proper clinical trial does not "prove" its treatment to be effective, but it actually should do its damnedest to show that any observed (net) benefits are down to simple statistical fluke, but then fail, leaving the positive result 'proven'. And obviously extract every possible risk factor in the process. (Thalidomide fell down badly on this, many years ago, partly because of the numbers involved and the fact that susceptible mothers were often taking a cocktail of multiple 'remedies' over much of the nine months, which made the reality slow to be teased out. But the lessons learnt mean that authorising anything for pregnant women are tortuous, and testing on (non-pregnant) women in general is hampered by having to account for menstral cycles, so we end up with far too many man-tested drugs that say "not for use in pregnancy" just to keep far to the safe-side, plus still far more unknown levels of efficacy/etc in the 'generic' female body than we should have. But it's being addressed. Onward, ever onward!) 162.158.159.49 23:14, 18 October 2021 (UTC)

The way I understood the title text was that the "change" was the one written in red, that is "now we have to do clinical trials". The title text's joke is thus that, because before that change clinical trials weren't part of the procedure ("standard of care"), you don't have to test the idea of testing ideas. Closely related to that "joke" is https://existentialcomics.com/comic/404 (but seriously this isn't a simple problem). 108.162.229.101 01:21, 19 October 2021 (UTC)

Shouldn't Test if it works be step 2? Have idea, see if it works, impliment? 172.68.129.137 01:52, 19 October 2021 (UTC)

No. Steps 1 and 2 both include elements of testing and exploration; you need to perform experiments to come up with a good idea and convince -yourselves- that it is, in fact, good, and then you likely need to perform or at least show more tests to convince others that it is, in fact a good idea. But the addition of clinical trials added a further "and then you need to double triple check that your idea actually works rather than that it seemed to work in your initial experiments" step to (try to) avoid bad side effects and false correlation. Mneme (talk) 02:40, 19 October 2021 (UTC)

Mention of "anti-worming treatments" in the explanation. This is misleading, and gives the impression that drugs can only have a single function. It's like talking about the use of "headache medicine" for preventing heart attacks. If you want to refer to a specific medicine, do so by name but make damn sure that your claims about that medicine are accurate Mneme (talk) 04:36, 19 October 2021 (UTC)

While the awareness of clinical trials is of course more relevant because of COVID, I don't think this is intended to be topical. The title is very straightforwards-- "the invention of clinical trials" and is almost joke-less (basically just the format). The real joke is in the title text, where it's pointed out that because the "standard of care" before the invention of clinical trials was not to do clinical trials, we didn't need to go through this step to start doing them; just convince people it was a good idea. 02:40, 19 October 2021 (UTC)

I think it's *extremely* topical, with the relatively recent debunking of ivermectin as (yet another) substance that has been widely claimed, distributed, and mis-used as a supposed COVID preventative/cure. BunsenH (talk) 03:49, 19 October 2021 (UTC)
If you like, it is topical by -context-, but not by content. Which is an interesting (but important) line to draw. Mneme (talk) 04:31, 19 October 2021 (UTC)

A recent editor pulled out my comment about how there isn't a joke, but I'd argue that that's necessary in some form. One of the reasons people go to Explain XKCD is that they're going "wait, did I miss a joke?" So explaining that as far as the community is concerned the main text is in-earnest education rathar than a missed joke does have an important purpose. Mneme (talk) 04:37, 19 October 2021 (UTC)

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