“The Randomized Controlled Trial: Gold Standard, or Merely Standard” begins by emphasizing the popularity of randomized controlled trials (RCT’s) over other types of research designs. Consequently, RCT’s are the easiest to obtain funding, and, though they are problematic in many instances, nevertheless receive priority over the observational studies that are sometimes more appropriate. RCT’s can consequently be said to have become a ‘gold standard’, but, if it can be shown that this type of research is not better than its alternatives in every situation, the use of this term to describe RCT’s will appear misleading. Randomization is but one good quality of research, and it cannot legitimately be said to be the best quality either. So why is it praised so highly? Furthermore, randomization appears futile when the sample size is small in comparison to other variables, or when there is an inadequate knowledge about alternative forms of treatment allocation also able to balance variables. Certainty of measurement is reduced in RCT’s by enlarged time frames between consecutive events. RCT’s are not particularly reliable in social contexts either due to the possible bleeding effects from the intervention to the control group, and because of disncentives to participation on behalf of the intervention and control groups. It seems therefore as though evidence based medicine’s (EBM) emphasis upon RCT’s as a ‘gold standard’ is illegitimate insofar as alternative research is comparably more effective in particular situations. An RCT might at times give considerably worse evidence than an observational study might.
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