Randomisation and resource allocation: a missed opportunity for evaluatinghealth care and social interventions

Equipoise is widely regarded to be an essential prerequisite for the ethica l conduct of a randomised controlled trial. There are some circumstances ho wever, under which it is acceptable to conduct a randomised controlled tria l (RCT) in the absence of equipoise. Limited access to the preferred interv ention is one such circumstance. In this paper we present an example of a r andomised trial in which access to the preferred intervention, preschool ed ucation, was severely limited by resource constraints. The ethical issues t hat arise when conducting randomised trials in health care are considered i n the context of trials of social interventions. In health, education and s ocial welfare, effective interventions are frequently limited due to budget ary constraints. Explicit acknowledgement of the need to ration interventio ns, and the use of random allocation to do this even in the absence of equi poise, would facilitate learning more about the effects of these interventi ons.