To the Editor.
—The article1 and the Editorial2 on RHC in critically ill patients highlight the potential dangers of intravascular instrumentation. As in our case-control study,3 the statistically more sophisticated multicenter study by Connors and the SUPPORT Investigators1 forms the basis for what should have been done decades ago—a randomized controlled trial. The authors recognize that without a randomized controlled trial, the results, while highly persuasive, cannot be conclusive. Indeed, the first call for a randomized controlled trial for such instruments was made in 1980.4 The University of Massachusetts Medical School study responded in 1987.3 The important point is that, just as soon as technical feasibility is available, diagnostic methods, like therapeutic methods, should have the most objective evaluation: in contemporary terms that means a randomized controlled trial. The distorted sense of ethics that inhibited physicians from referring patients to the SUPPORT trial1 is reminiscent of
Spodick DH. Effectiveness of Right Heart Catheterization: Time for a Randomized Trial. JAMA. 1997;277(2):113. doi:10.1001/jama.1997.03540260027025