In "Cost Containment: Death Knell or New Opportunity for Randomized Trials?" in the February 1994 issue of the Archives Hillis1 eloquently and appropriately defends the scientific validity and medical value of randomized clinical trials (RCTs) research: studies conducted under strictly controlled conditions to evaluate the efficacy of therapeutic interventions. Her Editorial and the accompanying "Resolution From the National Advisory Eye Council," while timely, are in danger of creating a polemic between those who support and conduct classic RCTs and those involved in observational studies and so-called outcomes research (OR). Randomized controlled trials and OR are complementary to, not substitutes for, one another.
If testing the efficacy of a treatment under strictly controlled conditions were the only consideration, then RCTs would suffice. However, the "translation" of RCT results into medically effective treatments in ordinary practice is the ultimate goal. Efforts in this respect have been directed to educating patients and
Bresnick GH. Cost Containment. Arch Ophthalmol. 1995;113(4):402. doi:10.1001/archopht.1995.01100040016003