Cancer and Clinical Trials

Abstract

Experiments, as Claude Bernard had shown, manipulate materials and processes in the natural world to determine underlying cause-and-effect relationships. To do this, experimenters seek to change certain known conditions and control for others, an inductive and powerful approach to problem solving. This drive for experimentalism, combined with the search for new therapeutic agents arising in the years before WWII, helped stimulate by mid-century perhaps the key methodological (we might even say ideological) innovation in twentieth century biomedicine, the randomized clinical trial (RCT). Although there are other claimants to the title of the ‘first’ controlled clinical trial, historians generally recognize the MRC’s 1946 study of tuberculosis treated with streptomycin³ as the beginning of the new movement.⁴ Part of the notoriety attached to the streptomycin trial came because its results were, unlike some earlier efforts, positive and clearly so.⁵ The original scarcity of the antibiotic had made the division of patients between a treatment group who got the drug and other groups who did not ethically straightforward (a feature of clinical trials that would become increasingly complex as I discuss in the next chapter), and helped to make the results clear and compelling.