Can Demonstration Projects be as Useful as Randomized Trials?
The Affordable Care Act is funding an Innovation Center, which was to spend $10 billion over a decade, to discover the most effective ways to deliver health care, and it already has some 40 demonstration projects underway. A New York Times story by Gina Kolata reports many researchers and economists are criticizing the center for not using randomized clinical trials (RCTs), long considered the gold standard for medical and social science research. Dr. David Conway, director of the center, defended demonstration projects, saying they allow researchers to evaluate programs in the real world, regularly adapt them, and stop them if they are not working. A senior fellow at the Center for Global Development, which advocates rigorous research, argues without RCTs there really is no evidence. Dean Ornish, founder and president of the Preventive Medicine Research Institute, asserts that size does not always matter, and that RCTs may introduce biases of their own. He calls for more creative research methods. Read his Edge.org essay.