Limitations of randomised controlled trials

BMJ 1995; 310 doi: https://doi.org/10.1136/bmj.310.6991.1410 (Published 27 May 1995) Cite this as: BMJ 1995;310:1410
  1. L Peter Fielding,
  2. Roger Grace,
  3. Rosemary Hittinger
  1. Chief Department of Surgery, Genesee Hospital, Rochester, NY 14607-4005, USA
  2. Consultant surgeon Oaken, Wolverhampton WV8 2BA
  3. Senior audit coordinator, surgery, NHS Queen Elizabeth the Queen Mother Academic Surgical Unit, St Mary's Hospital, London W2 1NY

    EDITOR,—T C B Dehn has commented on the problems of accruing patients into randomised controlled trials, noting the understandable reluctance of patients to enter some trials (“I want the best treatment, doctor”) in which the patient's outcome (for example, time to death) is the main end point and, consequently, the patient is unable to benefit from thestudy directly.1 This raises a fundamental issue concerning the usefulness of randomised controlled trials in reliably identifying new clinical knowledge. Less recognised, but equally important, is inconsistent clinical enthusiasm to offer the …

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