> The original Remdesivir trial by the drug company was a high quality RCT (randomized control trial) - except that they stopped it early once they saw a statistically significant positive effect (even though the effect was somewhat underwhelming: just a couple fewer days of illness). To me this moving of the goal posts invalidates the quality of the RCT.
Based on what I've seen discussed, ending trials early is a fairly common (though admittedly contentious) practice in medical RCTs when you're dealing with very serious illnesses, especially when there are no alternative effective treatments[1].
The issue is that there is a tradeoff between an abundance of caution to procure conclusive results and giving patients access to medicine which "clearly helps". In an ideal world you would run every RCT for several years to figure out any possible long term effects and accurately determine efficacy, but there are many circumstances where you could argue doing so (if it's clear the medicine works during the early stages of the trial) is more unethical than giving people medicine which shows some promise to work.
But it should be noted that such trials are still solid science (the trial was an RCT), it just means you cannot take them as evidence of long-term efficacy.
Based on what I've seen discussed, ending trials early is a fairly common (though admittedly contentious) practice in medical RCTs when you're dealing with very serious illnesses, especially when there are no alternative effective treatments[1].
The issue is that there is a tradeoff between an abundance of caution to procure conclusive results and giving patients access to medicine which "clearly helps". In an ideal world you would run every RCT for several years to figure out any possible long term effects and accurately determine efficacy, but there are many circumstances where you could argue doing so (if it's clear the medicine works during the early stages of the trial) is more unethical than giving people medicine which shows some promise to work.
But it should be noted that such trials are still solid science (the trial was an RCT), it just means you cannot take them as evidence of long-term efficacy.
[1]: https://www.ahajournals.org/doi/full/10.1161/circheartfailur...