The ethics and science of placebo-controlled trials: assay sensitivity and the Duhem-Quine thesis

J Med Philos. 2006 Feb;31(1):65-81. doi: 10.1080/03605310500499203.

Abstract

The principle of clinical equipoise requires that, aside from certain exceptional cases, second generation treatments ought to be tested against standard therapy. In violation of this principle, placebo-controlled trials (PCTs) continue to be used extensively in the development and licensure of second-generation treatments. This practice is typically justified by appeal to methodological arguments that purport to demonstrate that active-controlled trials (ACTs) are methodologically flawed. Foremost among these arguments is the so called assay sensitivity argument. In this paper, I take a closer look at this argument. Following Duhem, I argue that all trials, placebo-controlled or not, rely on external information for their meaningful interpretation. Pending non-circular empirical evidence that we can trust the findings of PCTs to a greater degree than the findings of ACTs, I conclude that the assay sensitivity argument fails to demonstrate that placebo-controlled trials are preferable, methodologically or otherwise, to active-controlled trials. Contrary to the intentions of its authors, the fundamental lesson taught by the assay sensitivity argument is Duhemian: the validity of all clinical trials depends on external information.

MeSH terms

  • Data Interpretation, Statistical
  • Drug Evaluation / ethics
  • Drug Evaluation / methods
  • Ethics, Clinical*
  • Ethics, Research*
  • Humans
  • Placebos*
  • Practice Guidelines as Topic
  • Randomized Controlled Trials as Topic / ethics*
  • Randomized Controlled Trials as Topic / methods
  • Reproducibility of Results
  • Treatment Outcome

Substances

  • Placebos