Abstract
During the recent era of evidence-based medicine, the randomized controlled trial (RCT) has been regarded as the most authoritative method of evaluating interventions. The methodology is utilized not only in medicine, but in other fields such as economics, education, and agriculture. In psychiatry and clinical psychology, RCTs have been utilized extensively in conjunction with the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM) [1]. This RCT/DSM combination has produced somewhat limited progress, both in identifying efficacious treatments and in facilitating progress in better understanding the scientific foundations of clinical intervention in these fields. This unhappy circumstance results not from limitations of the RCT as a tool of inductive logic, but rather its use with data that are neither theoretically grounded nor psychometrically sound, under background conditions in which publication bias and economic interest converge to distort the rational, impartial use of the RCT. Until the biases due to human interests are reduced and the fields of psychiatry and clinical psychology are more scientifically advanced, the RCT will be of limited use.
Highlights
The randomized controlled trial (RCT) has become the “gold standard” in outcome research evaluating both somatic and psychosocial treatments for psychopathology
What follows is a discussion of its limitations as an explanatory device when applied within psychiatry and clinical psychology and an explanation of why those limitations are problematic for those fields
Within the fields of psychiatry and clinical psychology, as they are presently constituted and operate within their cultures, the RCT is problematic as a tool of scientific inquiry
Summary
The randomized controlled trial (RCT) has become the “gold standard” in outcome research evaluating both somatic and psychosocial treatments for psychopathology. The progress of a clinical science based on the DSM/RCT framework, until recently, seems to have been greatly overstated and is being subjected to a revisionist analysis by numerous authorities.
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