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The limitations of randomized controlled trials in predicting effectiveness

Cartwright, Nancy and Munro, Eileen (2010) The limitations of randomized controlled trials in predicting effectiveness. Journal of Evaluation in Clinical Practice, 16 (2). pp. 260-266. ISSN 1356-1294

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Abstract

What kinds of evidence reliably support predictions of effectiveness for health and social care interventions? There is increasing reliance, not only for health care policy and practice but also for more general social and economic policy deliberation, on evidence that comes from studies whose basic logic is that of JS Mill's method of difference. These include randomized controlled trials, case–control studies, cohort studies, and some uses of causal Bayes nets and counterfactual-licensing models like ones commonly developed in econometrics. The topic of this paper is the 'external validity' of causal conclusions from these kinds of studies. We shall argue two claims. Claim, negative: external validity is the wrong idea; claim, positive: 'capacities' are almost always the right idea, if there is a right idea to be had. If we are right about these claims, it makes big problems for policy decisions. Many advice guides for grading policy predictions give top grades to a proposed policy if it has two good Mill's-method-of difference studies that support it. But if capacities are to serve as the conduit for support from a method-of-difference study to an effectiveness prediction, much more evidence, and much different in kind, is required. We will illustrate the complexities involved with the case of multisystemic therapy, an internationally adopted intervention to try to diminish antisocial behaviour in young people.

Item Type: Article
Official URL: http://www.wiley.com/bw/journal.asp?ref=1356-1294
Additional Information: © 2010 by John Wiley & Sons, Inc.
Library of Congress subject classification: R Medicine > RA Public aspects of medicine
Sets: Departments > Social Policy
Research centres and groups > Centre for Philosophy of Natural and Social Science (CPNSS)
Departments > Philosophy, Logic and Scientific Method
Rights: http://www.lse.ac.uk/library/usingTheLibrary/academicSupport/OA/depositYourResearch.aspx
Identification Number: UT ISI:000276170100002
Date Deposited: 06 Aug 2010 13:25
URL: http://eprints.lse.ac.uk/28826/

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