Intended for healthcare professionals


Giving medicine a fair trial

BMJ 2000; 320 doi: (Published 24 June 2000) Cite this as: BMJ 2000;320:1686

Trials should not second guess what patients want

  1. Richard Ashcroft, lecturer
  1. Department of General Practice, Imperial College School of Medicine, London W2 1PG

    Evidence based medicine requires clinical trials, but these are often hampered by a misunderstanding of the relation between controlled experiment and “routine” health care. The debate in research ethics should now focus on the usability of clinical trial evidence and the fairness of the design and timing of trials.

    What do patients want from doctors in the way of treatment? Only what is best for them as individuals. Doctors want and intend the same for their patients. Sometimes there is uncertainty about which treatment is best. Which to choose? And how? Suppose we are considering not one patient but many. Does this make any difference?

    Considering large groups of patients, uncertainty comprises both uncertainty about what to do for each individual and uncertainty about the intrinsic merits of the treatments themselves. Uncertainty about the treatments themselves is now generally agreed to be a solid reason to perform a clinical trial. Arguably such a trial is morally necessary. If one of the treatments is actually better, in terms of …

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