Clinical trials are predicated on the concept of equipoise: we know the existing situation, and have a proposed new treatment, intervention, or diagnostic method that may result in improvement in some meaningful outcome, whether that be longer life, less illness, or cheaper treatment. That improvement is not known as a certainty, and so must be tested in a robust manner. Randomized controlled trials (RCTs) are, in many circumstances, the best mechanism for testing a hypothesis in an unbiased manner, and are generally considered the gold standard for evidence.
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