We use properly conducted clinical science to give us a framework for interpreting the data we see, comparing data we have to studies with appropriate external validity to allow that comparison.
And no, there isn’t, if an RCT is at all feasible. There was a great paper a few years back that reviewed various case-control studies for conditions that were ultimately explored using RCTs (eg, knee arthroscopy, internal mammary artery ligation). What they found was that the retrospective study consensus was basically a coin-flip with respect to the RCT consensus. They just don’t provide useful data - too many confounders, known and unknown, go unaddressed.
> We use properly conducted clinical science to give us a framework for interpreting the data we see, comparing data we have to studies with appropriate external validity to allow that comparison.
I am extremely skeptical that this is in fact an even approximate description of how medicine actually works. Maybe not what you're doing! But what almost all of the doctors I've ever seen? They're not keeping up with all of clinical science. And even if they were, lots of clinical science is not being properly conducted. Just listen to or read the gripes that the statisticians have!
My previous claim still stands; you wrote:
> I, as a lone doc, am not equipped to make heads or tails of un-randomized un-controlled piles of data.
An individual patient, provides "un-randomized un-controlled piles of data" to their doctor – or, rather, not even piles of data. There's the visual evidence available from looking at and watching a patient when they're visiting your office (or whatever). There are sounds, smells, touch too. Then there's the verbal evidence. Then there's the results of whatever tests it is you order. If that's not un-randomized and un-controlled data, I don't know what is.
There's no framework for interpreting all possible medical evidence, even for the smallest professional specialties. There are no RCT for medical expert systems; none that anyone could legally use instead of a licensed doctor.
And there are lots and lots of interventions that doctors perform that have never been adequately studied in the form of RCTs. Doctors, in the real world, exercise an incredible degree of latitude with regard to what interventions they can perform based on their own personal judgement.
I’m not ignoring your request; in trying to dig up the paper, I came across a couple papers with data claiming to show the opposite. I’m trying to digest it all before returning to this topic, so I can give a more useful response. And I haven’t found that paper yet.
Isn't that a description of literally what every practicing doctors, that isn't involved in research, actually does?
And clinical trials are extremely expensive. Surely there's some utility in gathering data between the extremes of doctor-patient and clinical trial.