Commentary: Randomized trials of controversial social interventions: slow progress in 50 years

The attached paper—a study of caning schoolboys—is remarkable in many respects. In particular, it illustrates battles that are ongoing even half a century later around the ethics, feasibility, desirability and political acceptability of randomized trials (RCTs) outside medicine. For many working in medical research, it can seem peculiar that randomized trials are resisted in other fields. There are frequently situations in education, policing, criminal justice, employment and other areas of policy where RCTs could be practical and informative, especially: where there is arbitrary variation in the use of a particular intervention; where there are broadly reliable and valid outcomes to be measured; and where strong claims for effectiveness are being made. Trials outside medicine have, however, been slow to come. The prospect of an RCT on beating children provides a good—if extreme, and rhetorically dangerous—opportunity to explore the broader objections to RCTs outside medicine. First, it is important to note that the attached paper was not a randomized controlled trial of caning. This was not for want of trying. In fact the work by Palmer on caning is mentioned twice, in passing, by Archie Cochrane in his 1972 monograph Effectiveness and Efficiency, one of the founding documents of evidence-based medicine (it is also discussed at some length in Cochrane’s autobiography). Initially he uses the paper to illustrate the weaknesses of data from research into the effectiveness of interventions where participants are not randomized: