The remarkable thing is that treated patients died at nearly 3x the rate of non-treated patients, a rate that would be readily apparent in any modern observational study, yet people consistently cite this the best example of why randomized trials are vital. If an observational study today found a treatment working this badly, would you demand a proper RCT before acting? How long did the CAST study take? What prompted it in the first place?
The remarkable thing is that treated patients died at nearly 3x the rate of non-treated patients, a rate that would be readily apparent in any modern observational study, yet people consistently cite this the best example of why randomized trials are vital. If an observational study today found a treatment working this badly, would you demand a proper RCT before acting? How long did the CAST study take? What prompted it in the first place?