Friday, May 2, 2014

The ethics of randomized controlled trials

Objections to the idea of randomisation aren’t new. The great epidemiologist Archie Cochrane once ran an RCT of coronary care units, with the alternative treatment being care at home. He was vigorously attacked by cardiologists: how could he justify randomly denying treatment to patients? The counter argument is simple: how could we justify prescribing treatments without knowing whether or not they work? ...

Then there is the question of who consents. Camilla Nevill of the Economics Endowment Foundation says that trials are often agreed to and conducted by schools. Trying to persuade every parent to agree explicitly to the trial “decimates” the number of participants, she says.

Is this ethically troubling? At first glance, yes. But there is a risk of a double standard. Without the EEF funding, some schools would adopt the new teaching approach anyway. It is only when a researcher proposes a meaningful evaluation that suddenly there is talk of informed consent.