Can unequal be more fair? A response to Andrew Avins

In this paper, we respond to Andrew Avin's recent review of methods whose u se he advocates ill clinical trials, to make them more ethical. NC recommen ds in particular, "unbalanced randomisation". However, we argue that, befor e such a recommendation can be made, it is important to establish why unequ al randomisation might offer ethical advantages over equal randomisation, o ther things being equal. It is important to make a pragmatic distinction be tween trials of treatments that are already routinely available and trials of restricted treatments. We conclude that unequal randomisation could, ind eed, be an critical compromise between protecting the interests of particip ants and those of society?