Clinical trials are ailing

IN MAY 1941 Archie Cochrane was captured by the Germans. Clever, curious and bored, the young doctor passed the time in his Greek prisoner-of-war camp treating his fellow inmates—and conducting trials on them. In one, he measured the effects of yeast consumption on beriberi (it worked splendidly). In another, he tried international relations: did Yugoslav prisoners like British ones more or less after meeting them? (The results “were depressing”.) But one question obsessed him: did his medical treatments work? Too often, he wrote, “I had no idea whether I was doing more harm than good.”

“I will do no harm” is the Hippocratic oath. But for a long time, most doctors had no idea whether they were doing harm. Many didn’t mind. A wartime medical pamphlet relished doctors’ right to give whatever treatment they fancied. It was, Cochrane wrote, “ridiculous. I would willingly have sacrificed all my medical freedom for some hard evidence.” For the rest of his life Cochrane would be obsessed by one idea: better trials. In 1971 he wrote that doctors must run randomised control trials—what he called this “very beautiful technique”. Eminence-based medicine must give way to evidence-based medicine. A revolution had begun.

Now there are fears that it has stalled. The “very beautiful” idea is still beautiful, but it is also bureaucratic...