Finding evidence for treatment decisions in a pandemic

The randomized controlled trial (RCT) is the mainstay of treatment evidence in medicine because it is the most rigorously conducted and analyzed form of human research. Yet, the intense and detailed methodology that has evolved to implement RCTs has reduced their value in providing timely and useful evidence of the effectiveness of medical or public health interventions in pandemic conditions. The crisis conditions of a pandemic illustrate the need for medicine to take a broader view of the evidentiary landscape to include evidence from sources other than conventional RCTs. Such sources include analyses of vital data, observational research, quasi-experiments, and flexible RCTs carefully designed to address underlying biological and clinical realities and to avoid unnecessary rigidity.