Black Box Thinking: Why Some People Never Learn from Their Mistakes - But Some Do

by Matthew Syed

“The Randomised Control Trial is one of the greatest inventions of modern science.”8 It is probably worth emphasizing that RCTs are not a panacea. There are situations where they are difficult to use and where they might be considered unethical. And trials have often been rigged in subtle ways by pharmaceutical companies eager to come up with an answer that they have already prejudged.9 But these are not arguments against randomized trials, merely against how they have been corrupted by people with dubious motives. Another objection is that randomized trials neglect the holistic nature of a system. In medicine, for example, while a drug may cure a particular symptom, it may also have negative long-term effects on the rest of the body, or leave the underlying cause untreated. For example, prescribing a pill to combat a stomach complaint might cause damage to the immune system that could, in the long run, leave the patient worse off. What this objection is saying, in effect, is that the measurement period for a clinical trial shouldn’t be the immediate aftermath of administering a drug, but the entire life of the patient, and that the outcome shouldn’t merely focus on a particular symptom, but the whole person.