Randomized Controlled Trials

Media Review

CJEM 1999;1(1):72-73

Randomized Controlled Trials
Alejandro Jadad. 123 pp. BMJ Books, 1998. $39.95.

Most of us would agree that randomized controlled trials (RCTs) provide the best level of evidence. I also believe that many of us, without much hesitation, would accept as fact the results of an RCT if it were published in one of the more prestigious journals such as BMJ, NEJM, JAMA, or our own CJEM. But, was the study you read truly an RCT or just billed as such, and how can you tell? Are there different kinds of RCTs, and which ones are appropriate for a given research question? Furthermore, how does a simple emergency physician like me evaluate an RCT by someone like the great Brian Rowe or Ian Stiell? The answer to these and other RCT secrets is at your local medical school bookstore. Randomized Controlled Trials by Alejandro (Alex) Jadad was just released by BMJ Books in November 1998.

The author is an anesthesiologist with a PhD in epidemiology from Oxford University and currently holds several research positions at McMaster University. I know what you're thinking: "At last, a cure for my insomnia." Perhaps for a few that might be true, but those with any interest in research will be pleasantly surprised at how easy this book is to read and understand. It covers a wide array of RCT topics, including the difference between efficacy and effectiveness trials, the 36 types of bias, blinding and randomization strategies, interpretation and reporting and much more.

This is a must read for those brave souls who have accepted editorial responsibilities. Its 120 pages can easily be read in a day, and it doesn't take up much room on the bookshelf. Is there anything wrong with this book? Yes. It's too short. I think in the next edition the author might want to address some RCT methodological issues such as subgroup analysis (a.k.a. how I baffled them with bullshit when I couldn't sway them with science) and some of the more common statistical tests and their (mis)applications.

The last word on this book is: don't look at another RCT until you've read Randomized Controlled Trials by Alejandro Jadad.

Andrew Worster, MD
Cambridge Memorial Hospital
Cambridge, Ont.