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Research ethics and evidence based medicine
  1. R K Lie
  1. Correspondence to:
 R K Lie
 Department of Clinical Bioethics, National Institutes of Health, Building 10, Room 1C118, Bethesda, MD 20852, USA;


In this paper, the author argues that the requirement to conduct randomised clinical trials to inform policy in cases where one wants to identify a cheaper alternative to known effective but expensive interventions raises an important ethical issue. This situation will eventually arise whenever there are resource constraints, and a policy decision has been made not to fund an intervention on cost effectiveness grounds. It has been thought that this is an issue only in extremely resource poor settings. This paper gives an example from the United Kingdom illustrating that this is also a problem faced by richer countries.

  • NHS, National Health Service
  • NICE, National Institute for Clinical Excellence
  • QALY, quality adjusted life year
  • MS, multiple sclerosis

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  • The views in this paper are the author’s and do not represent the policies or positions of the National Institutes of Health, the Public Health Service, or the Department of Health and Human Services.

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