Ethics and statistics in randomized clinical trials.

Randomized clinical trials can present a scientific/ethical dilemma for clinical investigators. Statisticians have tended to focus on only one side of this dilemma, emphasizing the statistical and scientific advantages of randomized trials. Here we look at the other side, exam- ining the personal care principle on which the physician-patient rela- tionship is based and observing how that principle can make it difflcult or impossible for a physician to participate in a randomized clinical study. We urge that the view that randomized clinical trials are the only scientifically valid means of resolving controversies about thera- pies is mistaken, and we suggest that a faulty statistical principle is partly to blame for this misconception. We conclude that statisticians should be more sensitive to the physician's responsibility to the individ- ual patient and should, besides promoting randomized trials when they are ethically and practically feasible, work to improve the planning, execution, and analysis of nonrandomized clinical studies.

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