{"id":"40052dd9-3280-4e7f-a23e-6967a1dd3a17","slug":"tyranny-of-a-randomized-controlled-trials","title":"Tyranny of a “Randomized Controlled Trials”","authors":["Ben Roitberg"],"abstract":"Background: Evidence-based medicine emphasizes clinical decisions based on the best available scientific evidence. However, the classification of evidence quality, particularly the elevation of randomized controlled trials (RCTs) to the gold standard, raises concerns about the inherent biases and limitations of such studies, especially in surgical fields. Methods: This article critiques the reliance on RCTs in surgical research, discussing the methodological issues that arise when applying RCT designs to human subjects. It highlights the challenges of randomization, equipoise, and the variability of surgical practices that complicate the interpretation of RCT results. Results: The analysis reveals that many surgical RCTs suffer from profound methodological flaws, leading to misleading conclusions that may not accurately reflect clinical realities. The article provides examples of flawed studies that illustrate how improper design and patient selection can skew results. Conclusion: The article argues against the uncritical acceptance of RCTs as the primary source of evidence in surgical practice, advocating for a more nuanced approach to evidence generation that considers alternative study designs. It emphasizes the need for accumulating preliminary data to inform hypothesis generation before conducting RCTs. Keywords: evidence-based medicine, randomized controlled trials, surgery, methodological flaws, clinical research, patient selection, equipoise","thumbnailUrl":null,"publishDate":"2012-12-14T00:00:00.000Z","doi":"10.4103/2152-7806.104748","categories":["Original Article"],"fullTextUrl":"http://sni.wpengine.com/wp-content/uploads/2015/05/3494/SNI-3-154.pdf"}