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Evaluating new treatments

BMJ 1998; 317 doi: (Published 31 October 1998) Cite this as: BMJ 1998;317:1261
  1. Lawrence Cranberg
  1. consulting physicist, Austin, Texas, USA

    Fifty years ago medicine entered a new phase in evaluating new medical treatments in the form of randomised clinical trials, with control patients often given placebos. At the same time there was a widely accepted view that retrospective controls were “inherently fallacious.” But 20 years ago, this argument was challenged in the BMJ, and retrospective controls were advanced as an alternative to randomisation.

    It was recognised that the advent of modern computer technology made more practical the use of retrospective controls by facilitating the storage and retrieval of detailed medical data on past cases, and in comparing past with current medical experience. The BMJ endorsed this view. But the intervening 20 years have seen little change in practice. Today, randomised clinical trials with placebos are, with few exceptions, the prevailing method of evaluating new treatments. Yet alternatives surely warrant more attention than they have received— in particular, what is now usefully called a “computrial.”

    Alternatives surely warrant more attention than they have received

    A computrial is one which …

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