Are parachutes worthless? Most people would answer no—assuming the airplane in question was in flight. And that's the rub: That knee-jerk conjecture takes place out of context. Through a different lens, parachutes don't do anything at all because jumping from a plane on the ground is 100 percent harmless, and there's a study to prove it.
A group of professors of medicine conducted a satirical “”(PArticipation in RAndomized trials Compromised by widely Held beliefs aboUt lack of Treatment Equipoise) to illustrate the dangers of interpreting randomized controlled trials (RCTs) out of context. Topline results, after all, are just that—topline, and devoid of the numerous conditions that create a sound basis for analysis, and ultimately good medical practice.
When prospective participants were approached for the study, mid-flight, and asked whether they’d be willing to jump out of the plane without a parachute, it’s not surprising there weren’t any takers. The study protocol cheekily explains, “Owing to difficulty in enrolling patients at several thousand meters above the ground, we expanded our approach to include screening members of the investigative team, friends, and family.
The study involved 23 participants, most of whom were the investigators themselves, and concluded that parachutes did nothing to reduce death or major injury “upon impact with the ground measured immediately after landing.” This is funny because of course parachutes reduce death and injury when employed in the appropriate context, namely when plummeting thousands of feet toward the hard surface of the earth.
The idea that no one would ever jump out of a plane without a parachute is often used as an analogy to argue that randomizing participants to either a potentially lifesaving medical intervention or a control would be inappropriate. In other words, the determination of the control group versus the test group should be made by “,” not randomization. Those conducting the Parachute Trial disagree, with a footnote. They believe randomization is critical, and yet not uncompromised by preexisting beliefs about prevailing standards of care.
The parachute is the prevailing standard of care for jumping out of planes mid-flight. Jumping out of grounded planes, on the other hand, might require little more than a decent pair of shoes. Without careful attention to the context of an RCT, a doctor might recommend a treatment as absurd and paradoxical as the conclusions of the PARACHUTE study.