[nomel]

> Adderall is a strong counter to this idea. It is clearly effective per all of the tests it has been through.

That's a good example, because the statement "clearly effective" is absolutely false, as will be stated by a doctor when they prescribe it to you, and can be found in the documentation that comes with the medication. It is not appropriate or effective for some people, and is detrimental for others (accounts of both are found trivially online).

[taeric]

Adderall has some fairly clear cases where you shouldn't prescribe it, but this is largely not a secret list of "your unique biochemistry means we have no idea whether it will work for you" level of uncertainty. And, at large, this learning has been reinforced by RCTs. Such that I still don't see this as an argument against them?

[nomel]

You misread. I never made an argument against RCT.

> "your unique biochemistry means we have no idea whether it will work for you" level of uncertainty.

If by "work" you mean feeling something happen after you pop some pills, then sure...it's amphetamine.

If by "work" you mean "improved outcome", again, refer to the drugs documentation or are pharmacist, and also observe the existence of ADHD drugs that are not Adderall. The person prescribing it to you will quite literally tell you that it doesn't work for everyone, and go down the list of available drugs until you find something that, in fact "works for you", all entirely based on your personal response to the drug. Those reasons range from ineffectiveness (too high dosage requirement), unacceptable personality changes, to, of course, the rare full psychosis.

Difference in amphetamine response is well documented [1]:

> The clinical effects of amphetamine are quite variable, from positive effects on mood and cognition in some individuals, to negative responses in others, perhaps related to individual variations in monaminergic function and monoamine system genes.

Ritalin is also ineffective for some, for unidentified reasons [2]:

> The response rates to MPH among adult ADHD patients range from 25 to 78 % in controlled trials (Wilens et al. 2011).

[1] https://pubmed.ncbi.nlm.nih.gov/12716966/

[2] https://pmc.ncbi.nlm.nih.gov/articles/PMC4969350/

[taeric]

If you aren't against RCTs, then I don't think we disagree? Your post certainly makes it sound like you feel there are better ways than RCTs to get an idea of how well things work.

And fair that "work" is not necessarily a binary answer. I think we can easily agree there is no panacea out there. But that doesn't mean you can't make pretty good learning based on the trials.

In common probabilistic game terms, we know that most hands are not as good as pocket aces at hold em. Even if we can say that the aces will not win near 20% of the time.