Showing posts with label parachutes. Show all posts
Showing posts with label parachutes. Show all posts

A randomized controlled trial of parachutes had a surprising outcome. Anti-vaxxers, take note.

One of my themes in this column over the years has been that you need to be skeptical of many of the claims out there about science and medicine. A healthy dose of skepticism can be a good thing, especially when someone is telling you something that seems surprising.

On the other hand, anti-science forces often pretend that they too are just being skeptical, or “just asking questions,” when what they’re doing is actually science denialism. Denialism is what someone is doing when the science is basically settled, but they refuse to accept it.

Let’s consider perhaps the clearest example of denialism, and the one that causes the most harm to public health: vaccine denialism. The anti-vaccine movement, which has grown alarmingly fast during the Covid-19 pandemic, insists that vaccines don’t save lives, and even more they insist that vaccines cause neurological damage. The latter claim is a favorite of Robert F. Kennedy Jr., as he’s proclaimed in multiple books and articles, and of his VP running mate Nicole Shanahan as well.

The claim that vaccines cause autism was first promoted in a bogus 1998 article in The Lancet by Andrew Wakefield. That article was later shown to be fraudulent, and the journal retracted it, but not before it spawned the modern anti-vaccine movement and made Wakefield one of their heroes. I’ve written many columns on this topic, and others have written far more, but the movement persists.

Scientists and doctors have pointed out, over and over again, that vaccines have saved millions of lives, and are one of the greatest medical advances in the history of civilization. The rapid development of the Covid-19 vaccine was a triumph, and it undoubtedly saved tens of millions more lives.

In defending their denialism, anti-vaxxers frequently ask this question: “where are the randomized controlled trials for vaccines?” They imply that scientists haven’t run such trials because they (the scientists) know that vaccines don’t really work.

That’s nonsense, of course. Scientists have conducted hundreds of studies, involving millions of people, showing how vaccines prevent disease and death.

But we don’t have any randomized controlled trials for childhood vaccines, and we never will, for an obvious reason: it would be deeply unethical. Let me explain.

A randomized control trial (an RCT) works like this: first, you identify a large group of people whom you want to treat, say by giving them vaccines. Then you divide them at random into two groups: the treatment group, who get the vaccine, and the control group, who get nothing. To prevent bias, you might also “blind” the subjects and experimenters so that no one knows who’s getting treated. For example, you could use shots filled with saline solution for the control group, so they think they’re getting a vaccine.

Once you’ve administered the treatment, you follow everyone for some period of time and see who does better. If the treatment group does better, then we say that the treatment worked.

Obviously, we cannot run an RCT for childhood vaccines, because withholding vaccines from children could grievously harm or even kill them. Instead, we can use data collected over time from millions of children, some of them vaccinated and some not, and measure vaccines’ effects from that. It’s not perfect, but these observational data show overwhelming evidence that vaccines for diseases including measles, mumps, rubella, polio, and smallpox are incredibly effective.

Yet anti-vaccine activists continue to call for RCTs, and they pretend that scientists who point out what I just wrote are not to be trusted.

Now to those parachutes in the title of this piece. We know that parachutes work, right? And yet where are the randomized controlled trials? Maybe we shouldn’t use parachutes until some scientists conduct that study? Hmm.

Well, if you’re thinking of skydiving and wondering about this question, you’re in luck! Because a few years ago, a group of scientists at Harvard, UCLA, and the University of Michigan ran an RCT on parachutes! And they published it, too, in the highly regarded British Medical Journal, now called BMJ.

I’m sure you’re curious about how they did this study, and how it turned out. Well, I’m going to tell you.

It was a small study: they approached 92 aircraft passengers and enrolled just 23 people. They randomized them into two groups, with 12 people wearing parachutes and 11 jumping with just an empty backpack.

What happened? Amazingly, there was no difference! Also amazingly, no one died! How could that be?

Well, reading the details of this (ahem) well-executed study, one learns that “randomized participants ... could have been at lower risk of death or major trauma because they jumped from an average altitude of 0.6 m on aircraft moving at an average of 0 km/h.”

In other words, participants did jump from a plane, but they were jumping from less than a meter off the ground and the plane wasn’t moving. A figure from the study illustrates the experiment:

So as you see, this particular RCT of parachute use didn’t prove anything. Even so, the authors note, tongue in cheek, that “Beliefs grounded in biological plausibility and expert opinion have been proven wrong by subsequent rigorous randomized evaluations. The PARACHUTE trial represents one more such historic moment.”

In case you’re wondering how on earth the BMJ would publish a study like this, I can explain that the date of publication was Christmas 2018. The BMJ has a long tradition of publishing satirical but seemingly serious articles on Christmas, and this was a particularly good one.

On the other hand, though, my larger (and serious) point is that the public shouldn’t lose trust in science. Even when science gets things wrong–and it does–it’s still the best toolkit we have for figuring out whether or not something works, or is true. The recently popular cultural trope that truth is malleable, and that each person can choose their own “facts,” is dangerous. When it comes to scientific facts, that’s just wrong.

Parachutes work, and not using them would be exceedingly risky. Vaccines aren’t quite as guaranteed as parachutes, but they come pretty close.

Falling 300 feet and living to tell about it


How far can a human being fall and survive?  Normally, not very far.  People usually survive falls from a height of 20-25 feet (6-8 meters), but above that, things get very deadly very fast.  A study done in Paris in 2005 looked at 287 victims of falls, and found that falls from 8 stories (30 meters) or higher were 100% fatal.

How about 300 feet? Last fall, a remarkable case report appeared in an little-noticed journal, the Scandinavian Journal of Trauma, Resuscitation, and Emergency Medicine. The article begins with this astonishing sentence:
"We report the case of a 28-year old rock climber who survived an 'unsurvivable' injury consisting of a vertical free fall from 300 feet onto a solid rock surface."
This is no ordinary case report.  The accident happened when a 28-year-old woman and her boyfriend, both experienced rock climbers, were climbing in the Rocky Mountains in Colorado.  Both were wearing helmets.  The woman took the lead on the final pitch of a 300-foot (90-meter) climb.  At the very top, after securing the rope, her climbing harness failed.  She fell 200 feet straight down, hit a flat rock surface, then fell another 100 feet.  Her boyfriend climbed down as rapidly as he could, and found her at the bottom, alive.  This appears to be the highest vertical free fall onto a hard surface that a human has been documented to survive.

The list of the climber's injuries, described in detail in the article, is frighteningly long.  The article shows a picture of her, awake and off the respirator, on her 4th day in the hospital.  (The patient agreed to have her case published along with her photo.)  Despite her extensive injuries, including paralysis of both legs, she otherwise recovered remarkably well and "was transferred to her local community regional spinal cord rehabilitation center out-of-state at 2½ months after injury in excellent conditions."

The authors of the article focused on this question: if you fall a very, very long distance, how should you land?  The authors of the study concluded that a critical factor in the climber's survival was that she landed feet first.  As they wrote: " a fall on both feet represents the 'ideal' body to impact surface position with regard to survival from vertical falls."  Landing feet first allows the lower body to absorb most of the deceleration force, as they illustrated in the figure reproduced here.

This case reminds me of a famous paper from BMJ back in 2003: "Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials."  In that paper, G.C.S. Smith and J.P. Pell complained that no one has ever done a properly controlled experiment to determine if parachutes really work.
"We were unable to identify any randomised controlled trials of parachute intervention," they wrote.
They argued that "an adverse outcome after free fall is by no means inevitable," a point that the current study would seem to support.  However, I can't agree with Smith and Pell's conclusion: "We think that everyone might benefit if the most radical protagonists of evidence based medicine organised and participated in a double blind, randomised, placebo controlled, crossover trial of the parachute."