Leaving Therapy to Chance

Marquis analyzes the design of randomized clinical trials of drugs and concludes that randomization is incompatible with the obligations of the physician patient relationship. Statistical and administrative complexities make it difficult to halt a trial it has run its course, yet it is unethical to continue once there is that one therapy is superior to another. Strategies for resolving dilemma are proposed, but are shown to be ethically flawed upon closer. There appears to be no solution to the problem of reconciling demonstrable benefits of randomized trials with inevitable violations of therapeutic obligation. (KIE abstract)