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It is not the case that RCTs are not guaranteed to deliver reliable results
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Reasons For
1 perspective
Reason for
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1.
The label 'gold standard' suggests RCTs are guaranteed to deliver reliable results
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2.
Philosophers of medicine have argued that the claim RCTs are guaranteed to deliver reliable results does not hold to scrutiny
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Reasons Against
2 perspectives
Reason against 1 of 2
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1.
RCTs assume treatment effects are homogeneous across populations, but Cartwright (2007) shows effect heterogeneity undermines external validity.
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2.
A result reliable within a trial population may be systematically unreliable when generalized to clinical practice contexts.
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Reason against 2 of 2
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1.
Worrall (2007) demonstrates that randomization does not control for unknown confounders in any single trial, only in expectation across many trials.
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2.
A method that controls confounds only probabilistically across repetitions cannot guarantee reliability for any particular RCT result.
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