Biomedical Engineering Reference
In-Depth Information
Summary regarding RCTs
In summary, I believe that the implications of equipoise and of the
patient's compact with his or her doctor may in some circumstances
preclude randomization. Not every experiment can be done. Ethical
considerations may simply make it impossible to conduct RCTs even
though they are desirable on purely scientific or public health
grounds.
I am concerned that the doctor-patient relationship is at risk in this
enterprise, and that the trust the patient places in the doctor to do the
best that he or she knows how to do for him or her is at risk of being
eroded. There are already many sources of erosion of that confidence,
and randomized clinical trials are surely not the most important, but
the pressure to perform, promote and participate in randomized
clinical trials is, I think, an important source of concern. There is a
danger that patients will come to feel that their best interests are not
foremost in their doctor's minds, that their doctors are being less than
candid with them, or that they have suffered “for science”. If this
happens it will not be good for doctors, it will not be good for science,
and ultimately and most importantly it will not be good for patients.