Prof. Vincent never got it right

With all due respect to Prof Vincent, our problem is not the randomized clinical trial.

With all due respect to Prof Vincent, our problem is not the randomized clinical trial.

This post was inspired by a WhatsApp chat with Dr. Lawrence Lynn last Sunday. He reminded me of a 2010 opinion piece by Professor Jean-Louis Vincent, the world-renowned critical care guru. After talking to Lawrence I started thinking about the last three decades in critical care and how prominent Prof. Vincent has been. This is my creative process. When I overthink I need to write it down. What comes next are my words, not Lynn's.

Prof. Vincent authored hundreds of articles and gave an equivalent number of opening speeches worldwide. Most of all, he gave us FASTHUG and SOFA.

He was particularly productive in 2010. Then he churned out 49 papers, roughly one per working week. That's productivity! He wrote about ventilator-associated pneumonia, ARDS, microcirculation, procalcitonin, amikacin, severity scores, lactate, beta-lactams, ultrafiltration, dysglycemia (ugh), sepsis, septic shock, nitric oxide (so 90s…), corticosteroids, severity scores, protein C, among other topics.

The one I would like to discuss has the affirming title “We should abandon randomized controlled trials in the intensive care unit”. In the paper, Prof. Vincent acknowledges the generalized failure of randomized clinical trials in critical care. It proves that anyone can see the utterly obvious¹ failure, including those who have made a living by publishing critical care RCTs for decades. In a cursory PubMed search, I learned he published 42 RCTs after his 2010 epiphany. He has probably changed his mind.

In the article, there is a section where he attempts several possible explanations for such a monumental failure. He misses the elephant in the room in the first paragraph: