Who’s afraid of the randomized controlled trial? Some dilemmas of the scientific method and ‘good’ research practice

Abstract

This chapter focuses on the nature and uses of the methodology of the randomised controlled trial (RCT) in the light of recent critiques of science, including the feminist concern with the social structure of science as representing an inherently sexist, racist, classist, and culturally coercive practice and form of knowledge. Using the example of one specific RCT aimed at promoting women’s health, the chapter outlines some of the dilemmas thus raised for the pursuit of ‘good’ research practice.The RCT is essentially an experimental test (‘trial’) of a particular treatment/approach (or set of treatments/approaches) comparing two or more groups of subjects who are allocated to these groups at random (that is, according to the play of chance).The prerequisite for any RCT is uncertainty about the effects of a particular treatment. If something is known to work (and to be acceptable and without harmful effects), then there is no reason to put it to the test in the form of a trial. It is, however, this very issue of certainty/uncertainty that constitutes one of the central problems of the contemporary debate about RCTs. People can be certain that something (for example, streptomycin, social workers) is effective but have no ‘real’ basis for their certainty; conversely, unless they are able to admit uncertainty, ‘real’ knowledge can never be gained.The RCT has been increasingly promoted over recent years as the major evaluative tool within medicine. Over the same period, a new critical perspective has emerged, particularly within feminism (see, for example, Rose, 1986), towards what counts as ‘knowledge’ and the methods and techniques appropriate to its accumulation.