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Jeremy H. Howick writes in the book "The Philosophy of Evidence-based Medicine":

Perhaps the most striking [paradox of EBM] is that many of the treatments in whose effectiveness we have the most confidence – that we consider to be most strongly supported by evidence have never been supported by randomized trials of any description. These treatments include automatic external defibrillation to start a stopped heart, tracheostomy to open a blocked air passage, and the Heimlich maneuver to dislodge airway obstructions.

Is it true that there are no controlled randomized trials that support the usage of tracheostomy?

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    There are ethical considerations that must be considered when designing controlled trials. Many people have died as a result of the conditions you cite, and methods have been developed which appear to help. A proper controlled experiment would require that some automatic external defibrillators be modified to provide a placebo rather than a real electrical charge. Then the rates of survival would be compared to determine whether it really works or not. Is it worth denying immediate treatment to people to prove whether or not it works? How do you get their permission to participate? – Mark Apr 8 '16 at 12:00
  • @Christian-What about this review from Cochrane-ncbi.nlm.nih.gov/pubmed/25581416? – pericles316 Apr 8 '16 at 12:20
  • @Mark : The core idea of Evidence-based Medicine is that it's not enough that methods appear to help. The issue at hand is about how strict that prinicpe should be handeled. We already have a large thread about the Heimlich maneuver. The point of my question isn't to come to a particular conclusion but to know whether the example that Howick gives is correct. – Christian Apr 8 '16 at 12:37
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    @Christian I don't think your source is accurate. "These treatments include automatic external defibrillation to start a stopped heart" - this is not actually done. Applying an electric shock will not start a stopped heart, instead drugs are used. You will only see a defibrillator (which is used to stop fibrillations) used on a person suffering cardiac arrest (i.e. death) on TV, since in reality your heart needs to be beating in order to return it to a normal heart rhythm. – user1666620 Apr 8 '16 at 14:57
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    @Christian wikipedia: en.wikipedia.org/wiki/Defibrillation "Only the cardiac arrest rhythms ventricular fibrillation and pulseless ventricular tachycardia are normally defibrillated. This is because the whole point of the exercise is to shock the patient into asystole and then let their heart start back beating normally. Someone who is already in asystole cannot be helped by electrical means, and usually needs urgent CPR and intravenous medication." Skeptics: skeptics.stackexchange.com/questions/5046/… – user1666620 Apr 8 '16 at 15:25

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