[TaupeRanger]

And yet, due to its design, it is still entirely plausible that there is no, or very little effect. We just don't know.

The reason institutions delayed smoking has nothing to do with RCTs and everything to do with regulatory capture and corruption. Even in the presence of RCTs (which wouldn't be ethical, of course) this still would've happened.

That RCTs have failure modes does not change the fact that they are the best we have in the face of confounding variables - they simply require good design. This claim about Tdap is not like smoking...we don't have the same understanding of the underlying biology nor the massive effect sizes from other studies.

I have read the Book of Why and Probabilistic Reasoning in Intelligent Systems. There is nothing within those books to indicate animus against well designed RCTs. Rather he advocates, as I already did, for intelligent combination of sometimes sparse RCTs with the large N of observational studies.

[ncmncm]

Your wholesale invention of "animus against well designed RCTs" anyway explains your impassioned defense of fetishizing RCTs. I have never encountered any such animus, and doubt you have, either.

You reveal that you missed that Pearl spells out circumstances where observational studies do suffice to demonstrate what you insist requires an RCT.

And, you show you missed the entire section on the historical events that led to your and others' continuing fetishization of RCTs as the only possible means to demonstrate causation, and their lack to make any such demonstration impossible, which you continue to insist upon, against reason.

Your late admission that RCTs may be poorly designed, and thus fail to demonstrate what they claim, contradicts your previous fetishistic insistence on RCTs' infallibility.