First, I'm not sure that the 800,000 deaths are due to the medical guidelines themselves. If these guidelines were saying "we don't know, doctors still have to choose themselves", then the practitioners would have looked it up themselves and found Poldermans study and said "ok, no time to look into details, I have to choose, I have 0 study that says it's bad and 1 study that says it's good. I guess the best choice is to assume it's good". So, it feels like Poldermans' study would still have created a lot of problem.
I'm not sure what these guidelines are. Is it a proper organism, or is it just a "state of the practice"? Is it that the guidelines create the usage or the guidelines summarize the common practice? A bit like a dictionary will end up adding a definition because a word is used in a certain way, and these guidelines are just adding "more and more practitioners are considering this practice as the best one".
A second reflection that your interesting point made me think of is that "not making a decision" is also a "decision".
When a practitioner needs to make a choice, they have to make a choice, and "waiting for more study" is also a choice. In this context, they have to choose: I have one study that say it's good, I have 0 study that say it's bad, the one study that says it's good may be incorrect, but if the probability that it is correct is >50%, then the scientific best choice is still to do what the study says.
In other words: how many deaths would exist if someone would have waited for more data instead of following a study _that turns out to be correct_?
At the end, when you have one study, all you do is to bet on the probability that the study is incorrect (due to fraud or due to error) AND that the conclusion is incorrect (Poldermans could have been dishonest and faked his results to say that this procedure is good while in reality, this procedure is good). If this probability is still >50%, choosing to follow the conclusion is still scientifically better than not following the conclusion.
I'm not sure what these guidelines are. Is it a proper organism, or is it just a "state of the practice"? Is it that the guidelines create the usage or the guidelines summarize the common practice? A bit like a dictionary will end up adding a definition because a word is used in a certain way, and these guidelines are just adding "more and more practitioners are considering this practice as the best one".
A second reflection that your interesting point made me think of is that "not making a decision" is also a "decision".
When a practitioner needs to make a choice, they have to make a choice, and "waiting for more study" is also a choice. In this context, they have to choose: I have one study that say it's good, I have 0 study that say it's bad, the one study that says it's good may be incorrect, but if the probability that it is correct is >50%, then the scientific best choice is still to do what the study says.
In other words: how many deaths would exist if someone would have waited for more data instead of following a study _that turns out to be correct_?
At the end, when you have one study, all you do is to bet on the probability that the study is incorrect (due to fraud or due to error) AND that the conclusion is incorrect (Poldermans could have been dishonest and faked his results to say that this procedure is good while in reality, this procedure is good). If this probability is still >50%, choosing to follow the conclusion is still scientifically better than not following the conclusion.