Impure Politics and Pure Science: Efficacious Ebola Medications Are Only a Palliation and Not a Cure for Structural Disadvantage

Abstract

Caplan and colleagues (2015) present a strong argument for using alternative trial designs for experimental treatments for Ebola virus disease (EVD). This argument is, of course, not new. There is a significant body of work in the philosophy of medicine which highlights the moral authority given to RCTs and the fact that RCTs are often chosen not because they are needed but because people simply do not recognise that they can get evidence that is just as useful from other trial designs (Kerridge 2010). The popularity of RCTs as a research methodology is supported by positivist assumptions that well-conducted RCTs permit experimenters to make strong causal claims and conclusions because this trial design uniquely controls for confounding factors. RCTs do generally provide robust evidence, yet as the philosopher of science John Worrall (2007) demonstrates, randomisation, as a methodological principle, is not a sufficient condition to guarantee that the trial outcome will not be adversely influenced by uncontrolled or unknown factors. What this means is that RCTs are not necessarily epistemically secure or even always epistemically superior. But, like other trial designs, the data generated by RCTs needs to be interpreted in light of other sources and forms of evidence. This raises concerns that the epistemic and moral authority accorded to RCTs can mandate inappropriate and ineffective interventions, and divert attention and resources away from other ways of addressing problems.