Quantification and the quest for medical certainty

by J. Rosser Matthews

Since its inception in World War II, the clinical trial has evolved into a standard procedure in determining therapeutic efficacy in many Western industrial democracies. Its features include a "control" group of patients that do not receive the experimental treatment, the random allocation of patients to either the experimental or control group, and the use of blind assessment so that the researchers do not know which patients are in either group. Even though it has been only within the past generation that the clinical trial has moved to the forefront of medical research, comparative statistics in a therapeutic context has a much longer history. From that history J. Rosser Matthews chooses to discuss three crucial debates: that among clinicians before the Parisian Academy of Medicine in 1837, the debate in the German physiological literature during the 1850s, and, in the early twentieth century, the debate over the bacteriologist's diagnostic technique involving the "opsonic index." M