I don't think that was really his point. Frankly randomized controlled are as good as it gets. That doesn't mean they (as he points out) are immune to flaws or misinterpretation.
I can say there are a lot of conservative conclusions for political reasons in all forms of studies. Random controlled is only as good as it gets in terms of deciding whether a specific treatment should be paid for, not particularly for best medical practice, simply because there is no way of knowing whether the patient you are looking at falls into the beneficial group or not.
There is also the major inherent flaw of not being able to apply it to all patient populations. (with relatively stable populations the only ones studied)
In this case specifically I'm not sure why he is picking on this one. I didn't realize people were taking the results of the study to mean the treatments are equivocal (none of the vascular guys here interpreted it that way)..
I don't think anyone can really argue the benefits of intravascular vs open repair in many cases, not only this one. However, as I said above, if there is suddenly a bunch of evidence that a particular group wants to hear, like an insurance company, they are not going to pay much attention to the details of it. People do use the scientific method for political and economic purposes.
The problem comes in when there are times when open repair are beneficial, in the case of aneurysm, in the extremis, but if there is a reduction of payment, or obstacles to payment, then people are going to stop performing open repair, which translates to people whos only chance of benefit (not promised outcome) will not recieve treatment at all.
I would bet the conclusion of equality was meant to be conservative on purpose.
It is not that I am against evidence based medicine, it is just that I realize that often the evidence applies to a very small population. I think that a lot of the "evidence" for things is over valued. Not because of poor study but because of the actual statistical significance. It rarely even hits 10%.
But for the record, if somebody offered me a choice of open or intravascular repair of an aneurysm, I would pick intravascular unless there was actual rupture anyday and twice on sunday, no matter what the conclusion of a given study.
Again, this is just an argument for actually LOOKING at the damn papers as opposed to just reading the abstracts. . .
lol. Yes it is, but usually the only people who do that are already deeply involved in a given field and didn't need the paper anyway to know what the conclusions would be.
It goes back to my theory that every doctor is a scientist, making many observations over their career, the conclusions of which are no less valid than a published study.
