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Saloni
@scientificdiscovery.dev

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.

Saloni@scientificdiscovery.dev

Worth noting that many (not all) of the observational studies so far have been funded by GSK, which sells the shingles vaccine. Vaccines are great and the shingles vaccine is also great (for shingles), but people have got to be a little more skeptical of observational studies funded by pharma IMHO.

Saloni
@scientificdiscovery.dev

Placebo doesn't mean withholding the treatment, but they wouldn't get it as part of the trial. In this case, unlike for many other medical products like drugs, it's possible for people to get vaccines through another route and are similar to OTC. (Plus not as fraught as vaccines for fatal diseases)

Saloni
@scientificdiscovery.dev

But if it was still a concern, one could instead run a stepped wedge trial or another design in which all volunteers get the vaccine but at different time points.

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Saloni
@scientificdiscovery.dev

But they already are - e.g. the roll-out in Wales was by birth cohort, with specific single year age groups becoming eligible at a certain time and then other single year age groups becoming eligible in later years - which was the basis of the original study.