The randomised controlled trial (RCT) is one of the greatest inventions of modern science — a tool that allows you, more reliably than any other, to compare two or more interventions and determine which is more effective for a given purpose. It’s the standard by which we rightly demand that most medicines are tested before they’re approved. And one of the core arguments of The Geek Manifesto is that RCTs could be profitably applied to public policy in education, criminal justice and social issues much more frequently than they are.
There are, fantastically, voices in the Cabinet Office who agree. Last month, it published the results of a terrific collaboration between Ben Goldacre, the author of Bad Science, Professor David Torgerson, Director of the York Trials Unit, and Laura Haynes and Owain Service, of the Behavioural Insights Team at the Cabinet Office.
Their paper, Test, Learn, Adapt: Developing Public Policy with Randomised Controlled Trials, runs through several great examples where RCTs have already revealed powerful policy-relevant evidence — such as the effectiveness of sending personal text messages to remind people to pay court fines, and the ineffectiveness of paying people to attend adult literacy classes. It also offers a great introduction to the purpose and structure of well-run randomised trials. Goldacre describes it as the “Ladybird book of RCTs”.
Everyone should read this paper, especially if you work in Whitehall or Westminster. And everyone should email their MP to tell him or her to read it as well.
It’s a good moment to post another free extract from The Geek Manifesto — this time, about the role that RCTs could play in education policy. It begins here:
Teaching to the test
When people are asked what they consider to be the most important issue on the political agenda, education generally ranks second only to health. It is understood and accepted by British politicians of all parties that providing universal access to first-class medical care and providing excellent state schools that offer opportunity to all are among the core functions of government. Yet when it comes to evidence, these two central policy concerns are held to entirely different standards.
In healthcare, we expect drugs and medical procedures to be assiduously tested by the most rigorous appropriate methods before they are licensed for general use and before the state agrees to fund them. For the most part, this means assessment by randomized controlled trials (RCTs) – the most reliable method yet devised for determining whether or not a particular intervention really works.