CTSI Blogs

The Research Ethics Blog by Bernard Lo, MD

Ethical issues in Health Insurance Studies

A study based on Oregon's assignment of Medicaid by lottery has attrracted a lot of attention.  My understanding, which could be wrong, is that this was a natural experiment that resembled a RCT because of random assignment to the treatment, Medicaid.  I don't think it was an actual RCT.

Would this design be ethical if it were proposed as an RCT?

I know there have been issues with drug or treatment trials for HIV in Africa.  The realiity is that many people are untreated, but a study that leaves one arm untreated is not considered ethical.

It seems ridiculous that one can't do a study that measures the actual effect of a treatment in a population that ordinarily does not receive treatment, since the important question, whether from the standpoint of science, policy or ethics, is what the treatment would do in the real world.  And the real world often has the property of being unethical in that people live in conditions that harrm them.