Wider lessons of the pulmonary artery catheter trial

Intensivists are rising to the challenge of evaluating established practices

Although we demand rigorous scrutiny of the safety and efficacy of new products, clinicians have been slow to evaluate existing practices. This may be human nature—most clinicians pay lip service to the need to scrutinise and optimise current practice but generally believe it is others' practice, and not their own, that is suboptimal. Consequently, observational studies that show differences in outcomes associated with variation in practice are only rarely followed by randomised trials. A trial soon to get underway in British intensive care units is one such exception: from it, the rest of medicine may be able to learn much about having the courage to look within and to seek to practise better medicine.

One reason why it is hard to question existing practice is that clinicians often feel it is unethical to submit a particular aspect of their practice to randomisation, irrespective of the evidence against that practice. But with such a position, how can we ever progress? What is the ethical difference between denying a patient in the control …