Intended for healthcare professionals

Rapid response to:

Hazardous Journeys

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

BMJ 2003; 327 doi: (Published 18 December 2003) Cite this as: BMJ 2003;327:1459

Rapid Response:

Fun, but perhaps not so much

On one level, this is a funny article. I chuckled when I first read
it. On reflection, however, I thought "Well, maybe not," because a lot of
people have died based on physicians' arrogance about their ability to
judge the efficacy of a treatment based on theory and uncontrolled

Several high profile medical procedures that were "obviously"
effective have been shown by randomized trials to be (oops) killing people
when compared to placebo. For starters to a long list of such failed
therapies, look at antiarrhythmics for post-MI arrhythmias, prophylaxis
for T. gondii in HIV infection, and endarterectomy for carotid stenosis;
all were proven to be harmful rather than helpful in randomized trials,
and in the face of widespread opposition to even testing them against no
treatment. In theory they "had to work." But didn't.

But what the heck, let's play along. Suppose we had never seen a
parachute before. Someone proposes one and we agree it's a good idea, but
how to test it out? Human trials sound good. But what's the question? It
is not, as the author would have you believe, whether to jump out of the
plane without a parachute or with one, but rather stay in the plane or
jump with a parachute. No one was voluntarily jumping out of planes prior
to the invention of the parachute, so it wasn't to prevent a health
threat, but rather to facilitate a rapid exit from a nonviable plane.

Another weakness in this straw-man argument is that the physics of
the parachute are clear and experimentally verifiable without involving
humans, but I don't think the authors would ever suggest that human
physiology and pathology in the face of medication, radiation, or surgical
intervention is ever quite as clear and predictable, or that non-human
experience (whether observational or experimental) would ever suffice.

The author offers as an alternative to evidence-based methods the
"common sense" method, which is really the "trust me, I'm a doctor"
method. That's not worked out so well in many high profile cases (see
above, plus note the recent finding that expensive, profitable angioplasty
and coronary artery by-pass grafts are no better than simple medical
treatment of arteriosclerosis). And these are just the ones for which
careful scientists have been able to do randomized trials. Most of our
accepted therapies never have been subjected to such scrutiny, but it is
breathtaking how frequently such scrutiny reveals problems.

Thanks, but I'll stick with scientifically proven remedies.

Competing interests:
None declared

Competing interests: No competing interests

03 May 2007
Timothy R. Church
University of Minnesota School of Public Health