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Good intentions and received wisdom are not good enough: the need for controlled trials in public health
  1. Sally Macintyre
  1. Correspondence to Sally Macintyre, MRC/CSO Social and Public Sciences Unit, 4 Lilybank Gardens, Glasgow G12 8RZ, Scotland, UK; sally{at}


In the 1970s Archie Cochrane noted that many healthcare procedures and forms of organisation lacked evidence of effectiveness and efficiency, and argued for improved methods of evaluation, moving from clinical opinion and observation to randomised controlled trials (RCT). His arguments gradually became accepted in medicine, but there has been considerable resistance among policymakers and researchers to their application to social and public health interventions. This essay argues that opposition to RCT in public health is often based on a false distinction between healthcare and community settings, and sometimes on a misunderstanding of the principles of RCT in health care. It suggests that just as in medicine, good intentions and received wisdom are not a sufficient basis for making public policy and allocating public funds for social or health improvement.

  • Archie Cochrane
  • comm interven trials
  • evid based med SI
  • lack of evidence
  • objections to trials
  • randomised controlled trials
  • social and public health interventions
  • social inequalities

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  • Funding This work is supported by the UK Medical Research Council, wbs U.1300.00.006.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; not externally peer reviewed.

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