Journal Article

Seeing the Truth About Double Blinding

Zipursky, Jonathan S., Redelmeier, Donald A.

2024

Overview

Randomized clinical trials provide reassurances that confounding factors are balanced at baseline whereas blinding is essential to assure the balance of extraneous factors thereafter. This article provides a three-part taxonomy of pitfalls that can arise because of inadequate blinding in clinical trials. We introduce a cautionary framework for readers interpreting a blinded randomized trial for evidence-based medicine. Each pitfall is illustrated with a relevant example of a potential bias resulting from knowledge of group assignment. Several pitfalls occur during the conduct of the study including inadequate blinding of the intervention group, control group, or responsible clinicians. Additional pitfalls relate to data analysis including unsubstantiated assertions of blinding and subverted tests for blinding. Further pitfalls arise due to surrounding oversight including unblinding of research ethics boards and scientific reviewers. These caveats are sources of misunderstanding when observing the apparent connection between a clinical intervention and patient outcomes. An awareness of specific pitfalls might help advance the interpretation and application of blinded randomized clinical trials to inform evidence-based medical care.

• Publisher: Springer International Publishing,Springer Nature B.V
• Subject: Clinical trials / Data analysis / Double-Blind Method / Ethics / Evidence-based medicine / Evidence-Based Medicine - methods / Evidence-Based Medicine - standards / Humans / Internal Medicine / Intervention / Medical research / Medicine / Medicine & Public Health / Perspective / Randomized Controlled Trials as Topic - methods / Randomized Controlled Trials as Topic - standards / Research Design / Research ethics / Taxonomy