The second attitude towards effectiveness is an agnostic one; such a clinician considers previous real world experience more relevant than efficacy figures when it comes to assessing effectiveness. Randomized Controlled Trial (RCT) results are not dismissed, but are discounted nonetheless at a very high rate. To the agnostic reading about the efficacy of an intervention in an RCT only implies that both success and failure are possible outcomes but the reported figures are not relevant. If the outcomes in real world patients rein supreme, then the trial results should be quantified in such a way as to correspond to such an experience. An extreme version of agnosticism will mathematically translate such an assessment to have the minimum possible influence, or equivalently the least number of “additional” patients that should be added to the real world record: one success and one failure “pseudocase”.
The agnostic approach to effectiveness