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Rationality and the generalization of randomized controlled trial evidence
Author(s) -
Fuller Jonathan
Publication year - 2013
Publication title -
journal of evaluation in clinical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.737
H-Index - 73
eISSN - 1365-2753
pISSN - 1356-1294
DOI - 10.1111/jep.12021
Subject(s) - rationality , randomized controlled trial , generalization , psychology , medicine , epistemology , philosophy
doi:10.1111/jep.12021 The randomized controlled trial (RCT) is the gold standard of evidence because it has the highest internal validity; that is, its design is better than any other at preventing various sources of systematic bias from confounding our judgement. The preceding assertion has been amply rehearsed. It is precisely what is meant by the RCT’s placement above all other population study designs in the hierarchy of evidence for prevention and treatment deci-sions. The hierarchy has been the target of a battery of criticisms over the past two decades [1], yet it lives on in the most recent edition of the Users ’ Guides to the Medical Literature: Essentials of Evidence-Based Clinical Practice [2], and the randomized trial still rules. Recurrent among critiques of the RCT are concerns over its external validity [3–13]. The common thread to these argu-ments is that trials map poorly onto the reality of clinical medicine