Ten years ago I sat through a 2 year Masters programme in Health Services Research at the University of Sheffield.

I enrolled because I wanted the answer to one question, "How can I conduct meaningful practice-based research?"

First and foremost I am a clinician. I love seeing patients and I love the fact that I can make a difference to their lives. At least that is what they tell me.

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Since the first Randomised controlled trial in 1946, the RCT has become the "gold standard" for comparing different therapeutic modalities.

The RCT avoids selection bias by randomly allocating patients to placebo or treatment groups. Fair enough don't you think, unless you're a patient.

Imagine you took your car in for servicing and they asked you to sign a form agreeing to have your car randomly allocated into one of two groups, one using your regular oil and another using and experimental oil. 

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Randomised Controlled Trials are a great idea in theory but most are hampered with a near-fatal design flaw.

The controlled trial is an attempt to remove chance, bias and confounding from an experimental observation. By controlling or leaving unaltered as many of the “extenuating circumstances” as possible, it is hoped the the effects of the therapy can be ascertained.

Good randomisation is supposed to ensure that variables in patient selection are eliminated so that the results are not biased by selecting healthier, younger or better-suited people in one group or the other.

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