Are randomised trials needed in the era of rapidly evolving technologies?

New technologies are expensive. The health care budget cannot expand indefinitely so if new treatments are introduced they may have to displace other treatments, or prevent other new treatments coming into practice. This is not simply a money saving exercise; it is accepted that new high technology treatments may cost more to implement but they must be worth the money spent in comparison with other treatments. Therefore cardiothoracic surgeons must first demonstrate that our treatments are effective. Then we need evidence of cost effectiveness in comparison with other therapies.