Where there's will, there's a way

Randomised controlled trials (RCTs) are often considered an expensive way to gain knowledge. Frequently, that criticism leads researchers to use less expensive and less reliable procedures to address clinical questions. It is also sometimes suggested that major trials should be limited to research centres in countries that are economically well endowed. I think it is important to challenge these views, partly because the needs of developing countries do not always coincide with those of developed countries, and partly because not all RCTs need be expensive.

The history of the Argentine episiotomy trial provides an example to illustrate this alternative view. The trial started life in 1990 at a research unit in perinatal care in Rosario, Argentina, where I was a tutor. It emerged as part of the annual training course in clinical epidemiology in perinatology, supported by the International Development Research Centre in …