Randomised controlled trials in general practice

Gold standard or fool's gold? Randomised controlled trials are a widely accepted means of applying experimental methods to a clinical setting and have been advocated as the gold standard for comparing and evaluating different treatments.1 2 General practice has been promoted as an appropriate arena for evaluating interventions ranging from drug treatment to developments in services3 4: nine out of 10 health service consultations take place here; it is the point of first contact for most medical conditions; and existing population registers and computer systems allow potential access to large amounts of clinical data. An increasing number of randomised controlled trials are being performed in this setting to contribute to the culture of evidence based medicine.5 But despite the theoretical attractions, applying experimental methods in clinical practice presents problems that, if not properly addressed or acknowledged, may invalidate the findings.6 The particular problems of recruitment and randomisation merit consideration with respect to primary care. …