UK Medical Research Council and multicentre clinical trials: from a damning report to international recognition

Randomised controlled trial design pioneered.MRC scientists developed what is today the gold standard for clinical trial design while testing streptomycin to treat pulmonary tuberculosis.The website directs visitors to a British Medical Journal video made in 2009, in which Colin Blakemore, a neurophysiologist and former MRC Chief Executive, speaks to John Crofton (a pioneer of tuberculosis trials) and me about how randomisation and blinding in clinical trials has helped to generate reliable evidence to inform clinical practice.Surprisingly, the MRC itself has been curiously silent about the enduring value of its role in developing clinical trial methods and about the important methodological legacy left by the director of its Statistical Research Unit -Austin Bradford Hill.Stephen Lock, 1 a former editor of the British Medical Journal, has suggested that 'the randomised controlled trial is a British invention' and that Bradford Hill should have had a Nobel prize for his key role in helping to put medicine on a rational scientific footing.Although the MRC draws attention to some of the influential randomised trials that it has funded, it does not really celebrate the key role it played in the 1950s in developing and applying clinical trial methods (see Appendix 1).The MRC's achievements in this sphere had become clear by the 1970s, yet a two-volume, 700-page history of the MRC published in 1975 (made available on the Centenary website) assigns a mere five pages to 'Clinical evaluation of remedies' and fails to highlight the MRC's role in developing scientifically more robust study designs. 2 This is rather like referring only to uses of the polymerase chain reaction without referring to the fundamental importance of developing the method itself.Furthermore, reference to the important emergence of multicentre controlled trials is recognised in just two lines 3 in the 83-page report of a Wellcome Witness Seminar on clinical research in Britain between 1950 and 1980.4 How might the apparent reluctance of the MRC (and others) to take credit for something so creditworthy be explained?Research by Desire´e Cox-Maximov, 5 Ben Toth, 6 Martin Edwards 7 and Keith Williams 8 helps to explain the Council's lack of interest in controlled clinical trials during the 1930s.More research is needed to gather relevant data and understand the MRC's continuing lukewarm celebration of its role in developing clinical trial methods.I hope this article will help to prompt such research.