Post

Unpopular opinion but if you're interested in the effects of a medical product, it's 'RCT or bust' for me. I can see the case for observational analyses when randomization isn't possible, ethical, or the condition is too rare or some other such thing, but there's no such excuse here.

Once you establish efficacy against shingles it's not really ethical to do a placebo trial however.

Not ethical why? This would be an efficacy trial for its effect on dementia, not shingles, it's not universally recommended in most countries (though there's a case that it should be) and shingles vaccine uptake isn't very high anyway

You know there is a benefit and you are withholding that benefit. Equipoise?

If not universally recommended but researcher knows there is an established effect on shingles,is it really ethical to give a placebo without informing the participants they could benefit had they chosen to take the vaccine? I don't think so But you can't really randomise if you do provide this info

I think it's more of a cost/benefit analysis from a company perspective. A study is generally run to get an indication included in the label. The decision to spend the money to add an indication will depend on how much more drug will be sold with that indication. I'm not as familiar with dementia,

Very interesting there's already an RCT ongoing on this! It's quite strange though: unblinded, and the control group isn't asked to come in for tests or follow up. (But the whole population is in registry data.) I guess that would make it similar to a natural experiment, also unblinded.

Dan Zoster sounds like the name of an American news reporter. “… and now we go to Dan Zoster in Gloucester…”