Dear All,
I do not belive that either of the NEJM papers referred to
by Dr Djulbegovic are denying the value of the RCT. Indeed
Concato states that "Randomized, controlled trials will (and should)
remain a prominent tool in clinical research."
Rather than trying to overturn the current hierarchy of evidence they
seem to be trying to narrow the gap between methods (see steve
simon comments)
Evidence based practice should be rooted in the real world where
many limitations on the conduct of RCTs apply. If as it seems
observational studies may have more validity than previously
considered they should be seen complementary rather than
challenging RCTs.A good discussion of these issues can be found
in a paper by Black
http://www.bmj.com/cgi/content/full/312/7040/1215
BMJ 1996;312:1215-1218 (11 May)
Why we need observational studies to evaluate
the effectiveness of health care
Nick Black
john Platt
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