Why There's No Cause to Randomize

@article{Worrall2007WhyTN,
  title={Why There's No Cause to Randomize},
  author={John Worrall},
  journal={The British Journal for the Philosophy of Science},
  year={2007},
  volume={58},
  pages={451 - 488}
}
  • J. Worrall
  • Published 1 September 2007
  • Philosophy
  • The British Journal for the Philosophy of Science
The evidence from randomized controlled trials (RCTs) is widely regarded as supplying the ‘gold standard’ in medicine—we may sometimes have to settle for other forms of evidence, but this is always epistemically second-best. But how well justified is the epistemic claim about the superiority of RCTs? This paper adds to my earlier (predominantly negative) analyses of the claims produced in favour of the idea that randomization plays a uniquely privileged epistemic role, by closely inspecting… 
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215 Citations
Highly Influential Citations
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Background Citations
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Methods Citations
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215 Citations

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It is argued that at least in the case of medical research, the authors know enough about the relevant causal mechanisms to be justified to ignore a number of factors and that the stance of evidence-based medicine that RCTs are the best available method to assess a treatment’s efficacy is defended.
What does randomisation achieve?
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A response to Worrall and others who challenge the epistemological value of RCTs, which argues that randomisation offers no advantage over balanced systematic designs in which experimental and control groups are carefully matched according to known confounders.
Causality in medicine: getting back to the Hill top.
How necessary are randomized controlled trials
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Robert Northcott argues that RCTs are not always the best choice after all, and that the ethical ramifications of conducting an RCT must be examined case by case; there is no one-size-fits-all answer.
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The overall aims of this chapter are to compare the use of randomised evaluations in medicine and economics and to assess their ability to provide impartial evidence about causal claims. We will…
When to randomize, or ‘Evidence‐based medicine needs Medicine‐based evidence’
  • J. Concato
  • Medicine
    Pharmacoepidemiology and drug safety
  • 2012
TLDR
An argument is presented, with representative examples, focusing on comparative effectiveness research (CER) and promoting what can be called medicine-based evidence (MBE), to help clarify what randomization accomplishes and what it does not—from a methodological perspective.
Is meta-analysis the platinum standard of evidence?
  • J. Stegenga
  • Biology
    Studies in history and philosophy of biological and biomedical sciences
  • 2011
Do We Need Some Large, Simple Randomized Trials in Medicine?
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The still very influential movement in favour of ‘Evidence Based Medicine’ (EBM) that began at McMaster University in the 1980s was initially often regarded as endorsing the claim that only RCTs provide real scientifically telling evidence.
Why all randomised controlled trials produce biased results
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It is shown that these world-leading RCTs that have influenced policy produce biased results by illustrating that participants’ background traits that affect outcomes are often poorly distributed between trial groups, that the trials often neglect alternative factors contributing to their main reported outcome and, among many other issues, thatThe trials are often only partially blinded or unblinded.
Hunting Side Effects and Explaining Them: Should We Reverse Evidence Hierarchies Upside Down?
Philosophical discussions have critically analysed the methodological pitfalls and epistemological implications of evidence assessment in medicine, however they have mainly focused on evidence of…
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