5. The perils of the cohort study
I've been having a lot of thoughts lately about the unjustified supremacy of "scientific" clinical trials, based not on conjecture, explanation or hypothesis, but simply on observing "clinical outcome". My fundamental conclusion is that it's an injustice to the individual to treat them based on the average outcome of a population in a trial (and also forego individual-level scientific explanations - I mean this in the Deutschian way). Both ends of the spectrum of these kinds of clinical trials result in tragedy for the individual.
Outcome 1: where the individual benefits, but since the "studies" or "meta-analysis showed no significant difference between intervention and control arms", the intervention is no longer prescribed, recommended or funded.
Outcome 2: where the individual does not benefit, but since the "studies" or "meta-analysis showed a significant benefit of intervention compared to control", this individual is now stuck with an intervention that doesn't work for them, and side effects that make things worse. Often these individuals may be labelled "treatment resistant", which seems an odd perspective to take. What's even more disastrous is that the individual in Outcome 2 may well be the same individual in Outcome 1.
I don't think that our current crude adjustments for confounds such as age, gender, lifestyle etc. are enough to justify population-based science applied to complex, heterogeneous individuals. You could even argue that individuals get more complex as we learn more about them and collect more individual-level data. Worse than this, many trials tightly control confounds to demonstrate significant effects of their intervention, only to then deploy the intervention in the real world, where there is an abundance of the very confounds they initially restricted.
This symptom of population-level "scientific" observation is perhaps a result of the dogmatic approach to prioritise "objective", physical truths at the expense of nuanced, individual-level truths. More simply stated, it's what happens when you prioritise "stuff" over individual human beings.