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Great post! I'm going to borrow your last line and use it in my closing signature.

But to the point, I think such RCT's are unlikely to become more prevalent in the current fiscal environment of the scientific world. Registries of persons with intermediate phenotypes of disorders may prove to be a more cost-effective approach.

Bill Gardner

Thanks for the kind words, Kathi. Sadly you are probably right about support for research. But maybe we can print up some "Think evidence, not opinion" buttons and start a movement?

Daniel S. Goldberg

But Bill, this is simply a well-studied feature of the problematic that is evidence-based public health policy. Namely, that we frequently (usually?) lack evidence of reasonable, let alone high, quality that would be sufficient to guide us with a modicum of confidence on any particular public health policy question.

No one disagrees that the best answer to this problem is to obtain better evidence of sufficient quality, but that does not address the real-time problem that the data simply may not exist at the time a decision needs to be made.

So, while I certainly agree that we need more data, I have to ask what you think we ought to do in the absence of that data when we need to make a decision?

The fact of this problem, its commonality, and its significance is one of the main reasons expert consensus panels are utilized -- it is suboptimal, of course, but in the absence of quality evidence, it is adjudged as the least worst evil. This may be an incorrect judgment, but what would you suggest in the alternative?

Bill Gardner

Great questions -- see my next post...

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