|Randomised Controlled Trials are the worst
28 May 2008
The worst thing to happen to medicine is undoubtedly the Randomised Clinical Trial (RCT) - not for the information it does and doesn’t give us but for the way it has been used by government and tunnel visioned researchers to qualify some ridiculous practices under the heading “Evidence Based Medicine”.
As clinicians we are ‘encouraged’ (read ‘forced’) to ignore our clinical skills and acumen in favor of flow chart diagnosis and prescribing. It is virtually never mentioned how much morbidity and mortality modern medicine directly causes - recent analysis in the USA places iatrogenic problems as the country’s third biggest killer!
In addition we are using medicines on complicated people, often with multiple diagnoses and on a variety of drugs - RCTs are conducted in strict (non-clinical) settings using young, relatively fit and healthy people. I am always flabbergasted at the conclusions drawn from these to ‘inform’ normal clinic practice - the information is barely ever transferable!
The best thing to happen to modern medicine is the shake-up of the rigid paradigm that is now being forced on the ‘establishment’ by hoards of patients and practitioners giving a huge range of complementary practices their attention and confidence.
The narrow-minded view taken by a radical few is that we don’t know how these modalities work, therefore they can’t work. This attitude clearly needs to be counterbalanced by the many hundreds of thousands of people who use these treatments and (RCT be damned) find that they work!
Scientific curiosity, informed by actually hearing what people are saying, is the only way forward. Retire any ‘scientist’ who is not actively demonstrating a flexible and curious approach to investigating these complementary therapies, suspending thier predjudice and bias - after all, is this not the DEFINITION of a real scientist?
Geoff Woodin, UK