BMJ | 2021
Covid-19: What happened to randomised controlled trials?
Abstract
Covid-19: What happened to randomised controlled trials? Charles P Warlow emeritus professor of medical neurology Whenever there is widespread uncertainty about the balance between the benefits and harms of a therapeutic intervention—which clearly exists for the timing ofwhen to start invasive ventilation judging fromTorjesen’s article1—the solution is generally to do one or more randomised controlled trials (RCTs). It seems strange that thousands of patients with covid-19 have been randomised in drug trials but so few in non-drug interventions trials (though of course that has long been a general difficulty, perhaps reflecting a reluctance to evaluate non-drug interventions). The problem cannot be lack of funding because millions are being spent on covid-19 research, and there is certainly no lack of patients. Perhaps there is not enough uncertainty in the intensive care community, but maybe more important is that imposing the rigours of an RCT on an already overstretched service is just too much to bear. An RCT, however, does not have to be complicated and burdensome if it is stripped down to the essentials, using routinely collected data to characterise the patients and their outcomes. But it does need someone to organise it.