Randomized Controlled Clinical Trials

3 September 2002 Dear Editor, RANDOMIZED CONTROLLED CLINICAL TRIALS I was interested to read the article of Moyer et al. in the August 2002 edition of the Journal (Moyer VA, Gist AK, Elliott EJ. Is the practice of paediatric inpatient medicine evidence-based? J. Paediatr. Child Health 2002; 38: 347−51). However, I could not find any mention of patients enrolled on randomized controlled clinical trials. Rather, the patients were managed according to information based on the results of other randomized trials. This article, and many others in recent Australian and International journals seems to highlight the importance of evidence-based medicine, defined as treating patients according to the results of published randomized controlled trials. However, this misses the point that the best way to treat patients is on a randomized controlled clinical trial, and indeed without having patients on these, there will be no evidence in the literature. I believe that in many hos­pitals around the country the vast majority of patients are not managed on clinical controlled trials and this should be addressed at all levels. (The cynic in me thinks that evidence-based medicine has been hijacked by the finance departments of our hospitals as it is cheaper than managing patients on clinical trials!) I am only too aware that in paediatric oncology/haematology the studies published today report treatments from 5−10 years ago, as the studies are completed and follow-up data are collected and analysed before presentation even in abstract form. I would be doing my patients a grave disservice to treat them according to the published literature, rather than treat them on the multicentre randomized controlled clinical trials that will become the published literature. While other fields of medicine might not carry the feared outcome of malignant disorders, I have no doubt patients would benefit equally from access to the gold standard of therapy. It has often struck me as strange that the Ethics Committee of our Hospital seems to spend time worrying about patients treated on trials but no time roaming the wards of the hospital finding out why there are so many patients not being treated on randomized controlled clinical trials.