Sometimes, depending on the therapeutic area, and ethical imperatives, randomised trials are not possible. You then need to use medical judgement to make reasonable interpretation on the results relative to historical outcomes. This is commonplace in new Oncology products for example where even regulators will now accept exceptional evidence from non randomised studies by reference to historical response rates.
that’s how case studies can be interpreted here. And that’s what Docmscstuffins is getting at by saying surgeons value these reports. Yes, confirmation bias is a risk, and it would be wonderful if there existed a robust set of randomised head to heads, but there doesn’t. So we can only work with what there is. Case studies are better than no studies.
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