BMJ  2005;330:791-792 (2 April), doi:10.1136/bmj.330.7494.791-b

Letter

Need for expertise based randomised controlled trials

Expertise based design has shortfalls

The first 150 words of the full text of this article appear below.

EDITOR—Devereaux et al discussed the need for expertise based randomised controlled trials for surgical procedures.¹

Firstly, the use of expertise based designs does not necessarily enhance the validity of a surgical trial. Surgical outcome does not depend solely on the operation; other factors that influence the results of an operation are heterogeneous and immeasurable (postoperative management, the surgical team, equipment). A different bias is introduced by the expertise based design, the influence of the overall performance of surgeon A v B, and in this regard, expertise based design is not necessarily a more valid comparison of operation A v B.

Secondly, the use of expertise based designs does not necessarily enhance the applicability of a surgical trial. The expertise based design assumes that an operation will only be performed by a select few. This is rarely the case, and hence the results will not reflect the true performance . . . [Full text of this article]

Papworth Hospital, Papworth Everard, Cambridge CB3 8RE eric.lim@cvsnet.org

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