Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

Does the parachute study prove that research doesn’t matter? Part I

ResearchBlogging.org

Every now and then, somebody who doesn’t like science claims that research is not important and uses the reference of the parachute study.

Conclusions As with many interventions intended to prevent ill health, the effectiveness of parachutes has not been subjected to rigorous evaluation by using randomised controlled trials. Advocates of evidence based medicine have criticised the adoption of interventions evaluated by using only observational data. We think that everyone might benefit if the most radical protagonists of evidence based medicine organised and participated in a double blind, randomised, placebo controlled, crossover trial of the parachute.[1]

I had left out the conclusion of the study and added this 8/23/2012 at 10:00.

 

The parachute study authors make it clear that their paper is a satire. It appears in the Christmas issue, which is the most comedic of the BMJ (British Medical Journal) issues.
 

Notes
Contributors: GCSS had the original idea. JPP tried to talk him out of it. JPP did the first literature search but GCSS lost it. GCSS drafted the manuscript but JPP deleted all the best jokes. GCSS is the guarantor, and JPP says it serves him right.
Funding: None.
Competing interests: None declared.
Ethical approval: Not required.
[1]

And still people cite this paper as if it is serious evidence that evidence is not important.

The irony of people claiming that research proves that research doesn’t work seems to be lost on the anecdotalists.

Even otherwise intelligent people fall for this mistake. The reference to parachutes often gets a quick laugh – as long as people do not think about it.

Do I want to use a parachute that is not based on any evidence?
 

 

You can use the anecdote-based parachute provided by the ACME Alternative Parachute Company, Ltd.

There was this one time that . . . yada yada . . . twice . . . yada yada yada . . . and then he . . . I swear . . . and it totally worked!

I will use a parachute that is manufactured according to designs that have been well tested and constructed using materials that have been well tested.

What? Why am I not demanding double-blinded, randomized, placebo-controlled trials to prove that a parachutes works? Because EBM (Evidence-Based Medicine) and SBM (Science-Based Medicine) do not suffer from that ridiculous limitation.

Double-blinded, randomized, placebo-controlled trials are the best evidence, but only opponents of EBM and SBM pretend that these are the only forms of acceptable evidence. If double-blinded, randomized, placebo-controlled trials are not the only acceptable evidence, the punch line doesn’t really work.

I want a parachute that is based on good research.

I do not want a placebo parachute.

I refuse to earn a Darwin Award due to a placebo.

I am not rich enough to be wasting money on placebos. I do not have enough life insurance coverage for it to be worth it to anyone for me to substitute alternative medicine placebos for real medicine.

Footnotes:

[1] Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials.
Smith GC, Pell JP.
BMJ. 2003 Dec 20;327(7429):1459-61. Review.
PMID: 14684649 [PubMed – indexed for MEDLINE]

Free Full Text from PubMed Central.

Smith GC, & Pell JP (2003). Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials. BMJ (Clinical research ed.), 327 (7429), 1459-61 PMID: 14684649

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Comments

  1. Does the materials of a parachute affects how fast it drops

  2. parachutes are BORING!

    • Parachutes are probably much more interesting if you are falling toward the ground.

      The problem is that some of the people who do not like the results of evidence based medicine claim that this logical fallacy is a refutation of evidence based medicine.

      Medicine could be much more interesting if more people could understand the difference between evidence and logical fallacy.

      .

  3. The parachute study is meant to address persons who regard only level 1 evidence as evidence. It does not mean to suggest that one should proceed with zero evidence. In fact, we have great evidence that parachutes do indeed work, just not level 1 evidence (that’s why we divide them into various levels–some are better than others, but the lower levels may still be good and adequate). That is why the authors wrote the tongue in cheek article. They were being criticized for not having level 1 evidence by many so-called sober scientists who were rigid proponents of level 1 evidence. In fact, there are many items for which it is nearly impossible to obtain level 1 evidence. Try studying a really rare disease like Creutzfeldt-Jacob disease (incidence 1 in 1-2 million). For a level 1 study, you’d need to enroll millions and millions of participants, a nearly impossible feat (think of the funding alone, much less the feasibility) at present.

    Thus, even the authors support level 1 evidence. They are not refuting it. They are merely using humor to show and remind folks that level 1 evidence is not always available, not always feasible to obtain, and that other levels of evidence also count as evidence. As a reminder, there is not level 1 evidence that oxygen works during an acute heart attack either. That is because we do not withhold it from anyone to study it in randomized fashion due to ethical concerns and assumptions made from non-level 1 evidence.

  4. The parachute study is meant to address persons who regard only level 1 evidence as evidence. It does not mean to suggest that one should proceed with zero evidence. In fact, we have great evidence that parachutes do indeed work, just not level 1 evidence (that’s why we divide them into various levels–some are better than others, but the lower levels may still be good and adequate). That is why the authors wrote the tongue in cheek article. They were being criticized for not having level 1 evidence by many so-called sober scientists who were rigid proponents of level 1 evidence. In fact, there are many items for which it is nearly impossible to obtain level 1 evidence. Try studying a really rare disease like Creutzfeldt-Jacob disease (incidence 1 in 1-2 million). For a level 1 study, you’d need to enroll millions and millions of participants, a nearly impossible feat (think of the funding alone, much less the feasibility) at present.

    Thus, even the authors support level 1 evidence. They are not refuting it. They are merely using humor to show and remind folks that level 1 evidence is not always available, not always feasible to obtain, and that other levels of evidence also count as evidence. As a reminder, there is not level 1 evidence that oxygen works during an acute heart attack either. That is because we do not withhold it from anyone to study it in randomized fashion due to ethical concerns and assumptions made from non-level 1 evidence.

  5. Kevin, My response is
    Does the parachute study prove that research doesn’t matter? Part II.

    I will probably address the part of your comment on oxygen next week.

    I apologize for taking so long to respond.

    .

  6. Kevin,

    As a reminder, there is not level 1 evidence that oxygen works during an acute heart attack either. That is because we do not withhold it from anyone to study it in randomized fashion due to ethical concerns and assumptions made from non-level 1 evidence.

    I explain the problems with this in Does the parachute study prove that research doesn’t matter? Part III.

    .

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