Two Views Of Medical Science - Observational Research Versus Randomized Trials

"Two views about medical science seem to have split ever more apart over the past decades," says Jan Vandenbroucke (Royal Netherlands Academy of
Arts and Sciences and Leiden University Medical Centre, The Netherlands) in an essay in this week's PLoS Medicine.



One view, says the author, is that of medical researchers who rejoice in discoveries and explanations of causes of disease. "Discoveries happen when
things are suddenly seen in another light: the odd course of a disease in a patient, the strange results of a lab experiment, a peculiar subgroup in
the analysis of data, or some juxtaposition of papers in the literature."



The other view is that of medical researchers "whose aim is to set up studies to evaluate whether the patient's lot is really improved by the new
therapies or diagnostics that looked so wonderful initially." The most developed branch of evaluation research is the randomized trial of a drug
therapy.



Professor Vandenbrouke analyses in what respects these two views differ, and how they lead to opposite research hierarchies (with randomization on top
for evaluation and at bottom for discovery and explanation), and explores the reasons why we need both views.



"We need both hierarchies," says the author, "the hierarchy of discovery and explanation as well as that of evaluation. Without new discoveries
leading to potentially better diagnosis, prevention, or therapy, what would we do randomized trials on? Conversely, how could we know that a discovery
is useful, if not rigidly evaluated?"



Professor Vandenbrouke's essay is based upon the prestigious Austin Bradford Hill Memorial Lecture given at the London School of Hygiene and
Tropical Medicine on April 24, 2007.



On the 11th March, responses from John Ioannidis and Philippe Autier will also appear alongside the essay. You will be able to view them online
here.



Observational research, randomised trials, and two views of medical science
Vandenbroucke JP (2008)

PLoS Med 5(3): e67

Please click here to view article online




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