Oakley's case for using randomised controlled trials is misleading

BMJ 1999;318:944 ( 3 April )

Letters

Oakley's case for using randomised controlled trials is misleading

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EDITOR $---$ Oakley examines lessons in the history of the use of randomised controlled trials to evaluate social interventions.¹Her examination provides a misleading assessment of their usefulnessin the evaluation of contemporary health promotion interventions.She suggests that randomised controlled trials are "ignored orregarded with suspicion" by the discipline of health promotionand that "experts ... have resisted the notion that rigorous evaluationof their work is more likely to give reliable answers than theirown individual preferences." This is not the case, and in presentingcase studies from American social experiments she does nothingto address the fundamental flaws in the application of randomisedcontrolled trials to the evaluation of socialinterventions.

Three major issues have to be considered. The first concerns the unit of intervention. In all of Oakley's cases the studypopulation comprises individuals or family units. In many contemporarysocial interventions, whole populations or subgroups . . . [Full text of this article]