Clinical trials in uremia-time to reappraise.
The construct of any road map of the progress of medical knowledge reveals a long and tortuous road, full of errors, misapprehensions, blind alleys, and a perpetual shuffling between authority, heresy, and reason; but one of continuous growth and steady progress, albeit at variable pace and achievement at different periods of history. Numerous factors account for this cumulative progress, notable among which are the transmission, scientification, and mathematization of medical knowledge that ultimately account for the progressive evolution of medical care over time, from its primitive beginnings in antiquity to its present sophisticated state of accomplishment. It was the mathematical precision provided by quantification and statistical analysis that established certainty in medicine and ultimately changed the conjectural art of clinical practice to a disciplined science founded on clinical investigation, especially in therapeutics. Randomized clinical trials (RCTs) introduced in the 1950s have since been instrumental in establishing certainty in the practice of medicine. Regrettably, the proliferation of RCTs driven by biased hypotheses and pharmaceutical-industrial interests have created serious flaws in the results of the onslaught of new RCTs that need to be reappraised. Another unfortunate trade-off during this evolution has been neglect of the individual patient's inborn biological variation from the norm, mean, or median, an omission that has come to erode the personal in medical care.