Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials

This is a rapid response(!) having just read this thought provoking
article and earlier contributors. In the lighter vein, if parachutes
really are effective why do airlines not provide them - they are
potentially more use than lifejackets, which have no evidence base for
crash landings on the ground. Their introduction would make the pre-flight
briefing much more interesting.

More seriously, perhaps one outcome is we should ask where is the
Evidence Base for the place of EBM? There undoubtedly is a need for help
in deciding risks and benefits of marginal effects. However, data can
only be gathered by observation in some areas, such as studies in
premature babies or treatments of very rare conditions. Much of
paediatric medicine operates from previous observations and many medicines
are used outside their market authorisation by paediatricians. This does
not break any laws and is potentially life saving.

On the other side of the coin, often significant differences
statistically in trials are not significant clinically. Products
legitimate claims to increase outcomes by 100% could only increase lives
saved from 12 to 24 per 1,000 at a very high cost. Clinical trials in
volunteers may bear little relation to to real patients. Cancer risks
100% higher by rising from say 10 to 20 per 100,000 often hit the news
headlines. So, are we in need of a reality check? Have Smith and Pell
cleverly started a process of deciding where Evidence Based Practice best
fits? I hope so.

Competing interests:
None declared