Clinical Trials
Clinical Trials
1. Come up with new idea 2. Convince people it's good
[Scrawled in red as an afterthought, an arrow inserting it between item 2 and the original item 3] 3. Check whether it works
3. [Now scribbled over and amended to "4."] New idea is adopted
[Caption below the panel] The invention of clinical trials
The comic begins with a simple process for adopting a new idea just by convincing people that it is a good idea. The joke is that this skips the important step of checking whether it actually is a good idea. That correction presumably comes about after ideas are adopted which sounded good but turn out to be harmful. The comic captions the addition of this checking step as "the invention of clinical trials".
The purpose of clinical trials in medicine is to make sure that a new medicine works and doesn't have serious side-effects. One example of the dangers of failing to make sure that it doesn't have serious side effects is thalidomide , which caused a lot of birth defects. In a clinical trial, the effect of a treatment is compared to the effect of a placebo, or an existing treatment, to make sure it actually has a beneficial effect. (Earlier trials establish that it is even a viable candidate for testing and establishing possible dosages/regimens that can then be carried forward to a treatment (Phase III) trial.)
Before the invention of clinical trials, people generally didn't know, or at least had no way of confirming, whether medicines actually worked. Although many herbs and medicines were effective, others were no better than a placebo, and some medical treatments such as trepanation and bloodletting not only had no benefit (except for a very few rare conditions) but were very likely to be harmful. Those treatments that did work at all were mostly those that had been tried (for whatever reason ) and just happened to be useful, but others had neutral or even adverse effects, but still managed to not be so dangerous that subsequent recoveries from the original ailment—regardless of (or despite!) dangers inherent in such treatments—were taken as proof of their efficacy.
Similar to more recent examples, some earlier treatments may have been gradually discovered to help a particular condition only by noticing beneficial side-effects when consumed for sustenance or for unrelated medical 'guesses'. However, they also remained without the full scientific rigour so long as it remained a 'traditional remedy' with at best an oral tradition across many disparate practitioners, and no consistent effort to formalise or test the falsifiability of any findings.
At the time that this comic was published, the world was in the middle of the COVID-19 pandemic , which made the existence of clinical trials more relevant to the public, who waited eagerly for what sounded like good ideas to get through clinical trials and available to the general public… or fail clinical trials and not do that. During this frustrating wait, many unscientific claims have been made that various drugs or non-drug treatments are cures for COVID-19, making it difficult to convince believers to get real treatments. On the other hand, many people were skeptical about COVID-19 vaccines which were made available to the public for emergency use before the clinical trials were finished, or had concerns about whether the clinical trials were rushed or otherwise flawed due how quickly they were conducted compared to the traditional speed for vaccine development and approval.
In the title text, "Standard of care" refers to the previously accepted practice which a new medicine needs to be compared against. Because the original 3-step "standard of care" in this comic didn't include clinical trials before their adoption, we didn't need to do any testing in order to decide to start using them. If we had had them as the standard of care, then we would have had to perform tests before we added a step and it would have taken longer. This assumes that the process itself is subject to the same scientific rigor as medical treatment; in practice that would be more of a political change that is still not tested.
This comic can be viewed to criticize several extreme political proposals that are obviously bad ideas to most people, such as abolishing the nuclear family, making gay marriage illegal, blocking the development of renewable energy sources and defunding the police. People tested the latter in Seattle, and the test didn't go well .
1. Come up with new idea 2. Convince people it's good
[Scrawled in red as an afterthought, an arrow inserting it between item 2 and the original item 3] 3. Check whether it works
3. [Now scribbled over and amended to "4."] New idea is adopted
[Caption below the panel] The invention of clinical trials