The RCT turned 60 this year

In Uncategorized on December 21, 2008 by Danielle Tagged: , , , ,

Hello again and my apologies for neglecting my bloggerly duties.  I have indeed been looking for work, and the search will likely continue into the new year as, at this time, employers are, no doubt, busy doing an extra-cautious version of Christmas shopping.  I’m in Canada for Christmas and nothing has shocked me more than the fall of snow that greeted me when I arrived.  It does not snow at Christmas in Victoria.  Ever.  Alan, I hope you feel better!

Although I am sure that many fine minds have remarked on it this year, I wanted to mention that it is the 60th birthday of the start of the first randomised controlled trial in Britain.  There is some confusion as to which study was the first RCT.  The trial that started first was designed to test the efficacy of immunisation against whooping cough; however, it was shortly followed by an RCT on streptomycin for treating pulmonary tuberculosis.  The streptomycin paper is frequently cited as the first RCT because it beat the whooping cough paper to press by several years.

This anniversary does not paint an accurate picture of the RCT’s usage as, initially, of course, it was slow to be taken up as standard practice.  The first RCTs were quite small, so were not well-built for detecting a difference in the treatment and control groups.  “For example, many early trials of the treatment of myocardial infarction, stroke, and cancer, which were not large by modern standards, consequently led to the misleading conclusion that there was no benefit.”

Before the RCT, patients were allocated in an alternating fashion to treatment and control groups.  Thus, studies were at high risk of bias even if the investigator was blinded.

While many organisations consider RCTs to be a gold standard (Cochrane, etc.), the RCT design cannot be useful for all research questions, and equal emphasis should be placed on looking at how to make good qualitative and cohort studies, as these are the bricks and mortar of what forms a good topic for research in the first place.  This is my opinion, having run into the problem whilst searching for narrow questions.  Limiting to RCTs is no good if the question is something like “Does the removal of the hand jewelry and artificial nails and/or nail polish reduce the rate of surgical site infection?” as it will be unlikely that any RCTs (or many other studies, for that matter) have been conducted on this question.

A group called Project Impact is soliciting for exemplars of good RCTs from 1948 to now.  A register of added studies is available on their site, with names of studies, a link to a structured abstract on PDF (sometimes), and a mailto link to give one’s feedback on the study.

Have a Merry Christmas and Happy Holidays in the likely case that I do not blog until the New Year!


One Response to “The RCT turned 60 this year”

  1. An interesting post this about RCTs – I didn’t know about the ‘who was first?’ confusion.

    Did the snow remain for Christmas day, or was it gone by then?

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