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In memoriam: Dr Peter Fisher

I 've just received the sad news of the death of Dr Peter Fisher in a cycling accident in High Holborn, near The Royal London Hospital for Integrated Medicine, where he had been a leading clinician for many years.

Peter was a good friend and colleague in my years at the hospital, where he was consultant physician and Director of Research, as well as Editor-in-Chief of the journal Homeopathy. He was a convinced homeopath but always took an evidence-based approach to the subject; for example, he criticised opposition to vaccination on the part of some homeopaths as unscientific (and contrary to homeopathic principle).. Nevertheless he was largely responsible for changing the name of the hospital from The Royal London Homeopathic Hospital to its present form in 2010. This was a wise move which reflected the fact that the hospital now offers a range of complementary treatments, always in the wider context of modern clinical medicine.

Peter's death will be an irreplaceable loss to British homeopathy.

The history of the RCT

Many of us probably think of the randomised controlled trial (RCT) as a largely British invention dating from shortly after the second world war, but an interesting short paper in the NEJM shows that its antecedents go back much further (The Emergence of the Randomized, Controlled Trial: Laura E. Bothwell, Ph.D., and Scott H. Podolsky, M.D. N Engl J Med 2016; 375:501-504 August 11, 2016 DOI: 10.1056/NEJMp1604635).

RCTs thus represent the most recent outgrowth of a long history of attempts to adjudicate therapeutic efficacy. Their immediate ancestor, alternate-allocation trials, emerged as part of a trend toward empiricism and systematization in medicine and in response to the need for more rigorous assessment of a rapidly expanding array of experimental treatments. Alternate allocation represented a significant advancement for addressing clinical research bias -- but one that had limitations as long as it allowed foreknowledge of treatment allocation. Concealed random allocation merged as the solution to these limitations, and RCTs were soon supported by crucial public funding and scientific regulatory infrastructures.

This open-access paper is well worth reading.