Waiting for the results of randomised trials of public health interventions can cost hundreds of lives, especially in poor countries with great need and potential to benefit. If the science is good, we should act before the trials are done. Good science, we suggest, is taking the research to the problem rather than conducting the research in the tallest ivory tower the investigator can find. Randomised controlled trials are needed and, when appropriate, should be part of the empirical evidence necessary for decision making. The question is how much evidence is needed to move from research to practice, when the matter is life saving interventions in poor settings. The yardstick for decision making should take into account the risks and benefits in the local conditions, not those of an ideal situation.
Published in British Medical Journal, September 30 2006, 701-703