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Clinical trials: deliberations on their essence and value
1dr.franz.schelling@aon.at
Journal of Evaluation in Clinical Practice
|June 11, 2004
Summary
Clinical trials, central to evidence-based medicine, have limitations in predicting individual patient outcomes or disease causes. Their results are influenced by commercial pressures and may not offer absolute objectivity or reliability for medical knowledge.
Area of Science:
- Medical research methodology
- Clinical pharmacology
- Epistemology of medicine
Background:
- The evidence-based medicine movement prioritizes clinical trials as the primary source of medical knowledge.
- Standardized clinical trials are increasingly scrutinized for their practical application and epistemological significance.
Purpose of the Study:
- To critically analyze the epistemological significance of clinical trials in medical research.
- To evaluate the inherent limitations and validity of evidence derived from clinical trials.
Main Methods:
- Analysis of current claims regarding the importance of standardized clinical trials.
- Examination of conflicting observations in medical practice, using multiple sclerosis research as a case study.
Main Results:
- Clinical trial validity is often based on an illusion of objectivity, susceptible to commercial and publication biases.
- Results have limited value: they don't identify all drug reactions, predict individual efficacy, explain disease causes, or provide reliable data with larger groups.
Conclusions:
- Clinical trials cannot guarantee prevention or cure for specific diseases.
- Individual predictions from trials are only contingent due to incomplete correspondence between trial populations and individual patients.
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