Expertise based trials may be the way forward for evaluating surgical interventions

Although a randomised controlled trial is the best study design for evaluating pharmacological interventions, scepticism about whether it is best in non-pharmacological interventions (such as surgery) remains. Devereaux and colleagues (p 88) propose an alternative: the expertise based randomised controlled trial, in which participants are randomised to clinicians with expertise in intervention A or intervention B. They argue that increased use of the expertise based design will enhance the validity, applicability, feasibility, and ethical integrity of randomised controlled trials in surgery and other non-pharmacological areas.