It’s easy to say the convalescent plasma trial should have been a large randomized trial. But there is no Moderna behind a plasma RCT. It was designed at the start of a pandemic by docs wanting to save lives. It grew beyond their imagination. @DrMJoyner @ACasadevall1

It’s easy to say we need randomized trials. But public funding for investigator initiated RCTs are scant. Your own institution would not let you do an RCT without funding.

Also only by doing one can you recognize the number of people who have veto power over your perfect design

There is a difference between masks and vaccines. Between hand hygeine and hydroxychloroquine. It’s the difference between when an RCT is not needed versus where one is imperative.

In between there is a spectrum where decisions have to be made on risk benefit judgment calls.