How necessary are randomized controlled trials?
Northcott, Robert (2012) How necessary are randomized controlled trials? In: Munson, R. (ed.) Intervention and Reflection: Basic Issues in Bioethics (9th Edition). Independence, U.S.: Cengage, pp. 187-191. ISBN 9781133587149.
Randomized controlled trials (RCTs) are often deemed the gold standard for testing new treatments. This belief in turn justifies recruiting patients into such trials even when it is suspected that a new treatment is superior – although patients in the control group are thereby denied what might be the better treatment, we cannot know that the treatment actually is better, the thought runs, without conducting an RCT. But Robert Northcott argues that RCTs are not always the best choice after all. Rather, like any other method, they can go wrong sometimes, in several different ways. The main alternative to them is historical studies, which try to assess a treatment’s effectiveness from data not drawn from trials. These too can go wrong in several ways, and in the past have acquired a bad reputation. However, that prejudice has become outdated. The truer picture, Northcott argues, is that sometimes one method is preferable, sometimes the other. Things must be decided case by case. It follows that the ethical ramifications of conducting an RCT also must be examined case by case; there is no one-size-fits-all answer. An especially striking and emotional example concerns ECMO, a treatment for newborn babies with life-threatening lung problems. Historical studies indicated that ECMO was a major breakthrough, offering hugely increased survival rates. But it was still insisted that it also be tested in RCTs, in the course of which many babies receiving the conventional treatment died. A properly nuanced view of RCTs suggests that these deaths were tragically unnecessary.
|Item Type:||Book Section|
|School:||Birkbeck Schools and Departments > School of Social Sciences, History and Philosophy > Philosophy|
|Depositing User:||Robert Northcott|
|Date Deposited:||06 Aug 2012 09:58|
|Last Modified:||17 Apr 2013 12:33|
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