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Do you think the online EMB tools should be error free and peer reviewed before they are posted on the websites affiliated with our most respected institutions? Nik From: Evidence based health (EBH) [mailto:[log in to unmask]] On Behalf Of Djulbegovic, Benjamin Sent: Friday, November 09, 2012 12:17 PM To: [log in to unmask] Subject: Re: New treatments turn out better than the old ones just slightly more than half the time in randomized trials The statement illustrate the paradox to which I may have alluded before : (://www.ncbi.nlm.nih.gov/pmc/articles/PMC2782889/<http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2782889/>) The statement "Patients are entered onto the trial because the trialists believe that the experimental treatment is better. " indicate that trialists conduct the trials because they believe that they know the answer ( that is, they do not believe they are uncertain about effects of competing treatment alternatives). However, the statement "The control group treatment should be as good as that available outside the trial." contradicts the previous statement as it indicates requirement for uncertainty (= equipoise) to undertake a trial. Because of the requirement for this uncertainty, not all investigators "bets" ( beliefs) can be subjected to testing. Hence, uncertainty ( equipoise) is highly relevant for conduct of RCTs. [the disagreement in the literature continues about " whose uncertainty should count" - community of researchers ( clinical equipoise) , individual researchers ( uncertainty principle) or patients ( indifference principle)] The higher uncertainty, the greater probability that researchers cannot predict the results. (The results, however, will have a predictable distribution, as we previously wrote ...)the trials should continue until equipoise is sufficiently disturbed ie, when uncertainty is considered sufficiently resolved ...( which, admittedly does not happen in practice in vast majority of trials) Ben On Nov 9, 2012, at 2:54 PM, "Steve Simon, P.Mean Consulting" <[log in to unmask]<mailto:[log in to unmask]>> wrote: So what would you make of the following comment: "Equipoise is an irrelevance. Patients are entered onto the trial because the trialists believe that the experimental treatment is better. The control group treatment should be as good as that available outside the trial. Experimentation continues until either the trialists are convinced they are wrong (equipoise is reached) or they convince Society they are right." Stephen Senn, as quoted at http://www.bmj.com/rapid-response/2011/10/28/placebo-confusion. Steve Simon, [log in to unmask]<mailto:[log in to unmask]>, Standard Disclaimer. Sign up for the Monthly Mean, the newsletter that dares to call itself average at www.pmean.com/news<http://www.pmean.com/news>