EVIDENCE BASED CARE OF EATING DISORDERS - BEWARE THE GLITTER OF THE RANDOMIZED CONTROLLED TRIAL

Objective-The aim of this article is to discuss the practical issues i nvolved in developing evidence based treatment Sor anorexia nervosa an d bulimia nervosa Method-We discuss the limitations of randomized cont rolled trials in evaluating treatments Sor anorexia nervosa. We illust rate hour a different strategy is being used in a European Collaborati ve Research Programme. Results-Many randomized controlled trials of an orexia nervosa have been fraught with difficulties in particular probl ems with inclusion criteria and compliance. An alternative strategy, t hat is, a well-designed longitudinal observational study with sophisti cated mathematical modelling, has been used in a large-scale German pr oject and has revealed marked variations in models of treatment which are not explained by case mix. Discussion-the randomized control trial may, be an inappropriate method to evaluate treatment for anorexia ne rvosa. Information from longitudinal observational studies will profit both the scientific community and the providers of health care by pro ducing a wealth of new clinical information which can be used to shape service delivery equitably and effectively. A European-wide study, wh ich has the advantages of including a wide variety of health service p rovision, is currently underway and is an example of such an approach. (C) 1998 John Wiley & Sons, Ltd and Eating Disorders Association.