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Parachute use to prevent death, trauma when jumping from aircraft (2018) [pdf]

bmj.com

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Re: Parachute use to prevent death, trauma when jumping from aircraft (2018) [pdf]

#21

Is it typical for clinical trials to completely miss the point like this? I’d like to read a followup meta-analysis that focuses on the actual physiology — “Parachute use to prevent death … when hitting the ground ”. [shurely some mistake?]

It is you that missed the point, read the conclusions again and realise this is a statement about medical papers and randomized participants.

Re: Parachute use to prevent death, trauma when jumping from aircraft (2018) [pdf]

#22
post #15
post #12

What point is this article trying to make?

This para, buried deep in the paper, is the point: A minor caveat to our findings is that the rate of the primary outcome was substantially lower in this study than was anticipated at the time of its conception and design, which potentially underpowered our ability to detect clinically meaningful differences, as well as important interactions. Although randomized participants had similar characteristics compared with…

It's right in the abstract and conclusions though, not really buried.

Re: Parachute use to prevent death, trauma when jumping from aircraft (2018) [pdf]

#23

Is it typical for clinical trials to completely miss the point like this? I’d like to read a followup meta-analysis that focuses on the actual physiology — “Parachute use to prevent death … when hitting the ground ”. [shurely some mistake?]

What do you mean? The point is identifying if parachutes prevent death when jumping from air aircraft, it's in the title!

Re: Parachute use to prevent death, trauma when jumping from aircraft (2018) [pdf]

#24
post #12

What point is this article trying to make?

They state the point at the end, and it's serious point: if you were inclined to use "science" to argue against a certain intervention that some group believes in, you could do a randomized trial of that intervention, but manipulate the conditions so that the intervention is unlikely to help. The study would look right and sound right to some people. It would use all the best practices. And yet it would be a bullshit study.

I suppose an example would be comparing the death rates of people who'd been on a statin drug for a few weeks to those who weren't on the drug at all. You'd probably find no different in morbidity, which might suggest that statins don't do anything.

Re: Parachute use to prevent death, trauma when jumping from aircraft (2018) [pdf]

#26

Is it typical for clinical trials to completely miss the point like this? I’d like to read a followup meta-analysis that focuses on the actual physiology — “Parachute use to prevent death … when hitting the ground ”. [shurely some mistake?]

I don't think it's missing the point, but you do want to be aware of the context a little bit. Randomized controlled trials are often held up as the gold standard of evidence, and they are good when it is possible to carry them out, but the point of the linked study is that the kinds of treatments it is possible and ethical to perform RCTs for limit their applicability. In this case, it would be unethical and criminal to get volunteers to jump off airplanes at 10,000ft with placebo parachutes, and the kind of RCT it is possible to carry out (this study) does not show parachutes to be effective. Thus no RCT showing that parachutes are effective is possible.

Re: Parachute use to prevent death, trauma when jumping from aircraft (2018) [pdf]

#27

Is it typical for clinical trials to completely miss the point like this? I’d like to read a followup meta-analysis that focuses on the actual physiology — “Parachute use to prevent death … when hitting the ground ”. [shurely some mistake?]

What do you mean? The point is identifying if parachutes prevent death when jumping from air aircraft, it's in the title!

Perhaps it was intended as part of the satire. A whole new set of trials will be needed, from scratch, to investigate deaths caused by base jumping from cliff tops!

Re: Parachute use to prevent death, trauma when jumping from aircraft (2018) [pdf]

#28
post #12

What point is this article trying to make?

Studies, including RCTs, are often affected by selection biases introduced (intentionally or unintentionally) by how participants are selected and/or self-select. Even the gold standard RCTs are thus not guaranteed to produce valid (or rather, useful/non-misleading) results.

They thoroughly researched the effectiveness of parachutes on a pool of candidates at various speeds and altitudes. While the initial pool of candidates covered a variety of situations, for some reason, the pool of participants willing to actually participate in the study was heavily biased towards people in an aircraft standing still on the airport, with about 60 cm from the door to the ground.

The bias may have been further increased by the selection criteria where participants deemed mentally unfit by the investigator were excluded, and willingness to jump from an airplane at altitude with a 50% chance of an empty backpack increased the likelihood of exclusion.

The bottom half of the right column on page 4 explains how this is relevant for real world studies.

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