How should we understand “clinical equipoise” when doing RCTs in development?

World Bank Blogs

 Submitted by David McKenzie on 2013/09/02

 While the blog was on break over the last month, a couple of posts caught my attention by discussing whether it is ethical to do experiments on programs that we think we know will make people better off. First up, Paul Farmer on the Lancet Global Health blog writes:

“What happens when people who previously did not have access are provided with the kind of health care that most of The Lancet’s readership takes for granted? Not very surprisingly, health outcomes are improved: fewer children die when they are vaccinated against preventable diseases; HIV-infected patients survive longer when they are treated with antiretroviral therapy (ART); maternal deaths decline when prenatal care is linked to caesarean sections and anti-haemorrhagic agents to address obstructed labour and its complications; and fewer malaria deaths occur, and drug-resistant strains are slower to emerge, when potent anti-malarials are used in combination rather than as monotherapy.

It has long been the case that randomized clinical trials have been held up as the gold standard of clinical research… This kind of study can only be carried out ethically if the intervention being assessed is in equipoise, meaning that the medical community is in genuine doubt about its clinical merits. It is troubling, then, that clinical trials have so dominated outcomes research when observational studies of interventions like those cited above, which are clearly not in equipoise, are discredited to the point that they are difficult to publish”

This was followed by a post by Eric Djimeu on the 3ie blog asks what else development economics should be learning from clinical trials, in which he writes: Continue reading “How should we understand “clinical equipoise” when doing RCTs in development?”