The role of RCT in Immunity Boosting

This article helps us not to fall into some false claims prevailing in the society during Covid-19 scenario. From the time when Covid-19 started, you might be hearing about IMMUNITY BOOSTING advises from family, friends and medias. But what is the role of RCT in Immunity boosting ? Some of you may be wondering about the relation between these two. At least medical professionals should know it, even though it is important for everyone to know it.

During the final year Community Dentistry exam, we had a question to write a short note about RCT. The only RCT, some of us had heard till that day, was the abbreviation of Root Canal Treatment. Even though, our answers were blunders, many of us somehow managed to pass the exam. Before going to the final year subjects, let us have a quick glance to the lessons about Immunity to understand the topic.

IMMUNITY

In simple words, it is the capacity of being able to resist diseases. Mainly, immunity is of two types.

By birth, we have anatomic barriers like skin, mucous membrane and certain cells like neutrophils, macrophages etc. which has a phagocytic action to prevent us from diseases. It varies among individual, species, races etc. For example bats carry many viruses with them but they do not cause disease in them whereas if it enters human body, he could get affected. Take the case of the royal disease Hemophilia. In most cases, females remain unaffected from the disease even though they carry the diseased chromosome whereas males get affected. Like wise certain species shows immunity against specific diseases which is called innate /natural immunity (specific innate immunity) and with the anatomic barriers, different cells of the immune system fights against pathogens non-specifically (non-specific innate immunity). Now let us go through what Acquired / adaptive immunity is.

Most of you might have understood what is Adaptive immunity just by looking into the above flowchart.

Now, what does the medical abbreviation RCT indicate and why should we know about this ? Medical abbreviation RCT stands for Randomized Controlled Trial and not root canal treatment which is the common RCT among Dentists. Why is it important to know about this ? It was very well explained in our Community Medicine / Community dentistry textbooks. It is only after laboratory studies, animal studies clinical studies, meta analysis studies etc., a drug is said to be effective against a particular disease. And  this RCT is one of the most advanced method for studying the effectiveness of a particular thing during clinical studies.  Two similar groups are assessed for studying the effectiveness of a particular thing / drug.

1. Experimental group
2. Control group.

Among the two, one will receive the drug, whereas other will not.

We could all have bias. The word – bias, is also well explained in Community / Public health medicine text books. ‘Bias’ in simple words is our inclination or prejudice towards/against certain things. It will make the Research  group to think or search for evidence with partiality towards the answer they want. The members who participate in the experiment could also have bias. Suppose we are testing a Medicine which got positive results in invitro studies (laboratory), animal studies etc. and the result is well known. When we introduce it among the Experimental group of people – the people among the group who want positive result in the experiment may feel like or claim like their symptoms resolved after taking the medicines and those who does not believe in the drug or want negative result from the experiment may feel or tell their symptoms persist . The control group (who did not receive the medicine) also may feel like, the disease persists. If tiredness is a well known symptom of the disease; a non medicated individual on being tired might believe his disease persist, even if he is healthy. To prevent this, a placebo (something which has only a psychological benefit, but does not have any physiological effect) should be given to the control group without making them aware of the same. It is called blinding.

People who does the research and the group of people who participate in the experiment as experimental and control group, should not have a Bias. So a Randomization and double blinding (both researcher and the groups will not be knowing who gets the real medicine and who gets placebo) is required which must be confidential and well recorded by a third party. The studies should be published in peer reviewed scientific journals and meta analysis of different scientific studies have to be done.

This is the only scientific method to find out the effectiveness of a medicine.

Now, what does immunity boosting mean ? Does it mean, increasing the number of cells in immunity system? If so, leukemia (blood cancer) patients will be having more immunity as they have higher WBC count. But, we know it is wrong. Over reaction of immune system are the causes of Asthma, allergies, auto immune diseases etc. Acquired / adaptive immunity can only be received through the above mentioned methods in the flow chart. In a sense we can call vaccines as immunity boosters. There is no scientifically proven easy method which can change your Innate / natural immunity as many claim. And if you believe Immunity boosting is something which make us healthy or maintain the well being of the cells in the body, then you might be wrong as the only Scientifically proven way this could happen is through the following practices :

So, do not get mislead by the false claims. RCT (Randomized Controlled Trial) has a major role in determining the effectiveness of an immunity booster, if it exist. No such claimed immunity boosters have been found till date.

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