In search of social equipoise

Petticrew, Mark; Lock, Karen; Green, John; Phillips, Gemma

doi:10.1136/bmj.f4016

Cited by 23 publications

(27 citation statements)

References 20 publications

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“…Randomised controlled trials are used to help answer questions of causality but are rare in social and economic policy, with pragmatic and ethical barriers often cited as reasons for not conducting such trials. Importantly, however, the artificial setting of a trial may limit external validity as the contextual factors may modify interventions in unanticipated ways (Petticrew et al ., ). To overcome some of these limitations, recent studies have focussed on exploiting ‘natural experiments’ (Angrist and Pischke, ; Craig et al ., ; Dunning, ; Dunning, ; Petticrew et al ., ; Robinson et al ., ; Sekhon and Titiunik, ; Reeves et al ., 2016) or specific exogenous changes in milieu that assign individuals to either the intervention or the control groups through a process that is random or is ‘as‐if random’, such as winning a lottery or naturally occurring variation in the roll‐out of policy interventions (Dunning, ; Morgan and Winship, ).…”

Section: Introductionmentioning

confidence: 97%

Introduction of a National Minimum Wage Reduced Depressive Symptoms in Low-Wage Workers: A Quasi-Natural Experiment in the UK

et al. 2016

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SummaryDoes increasing incomes improve health? In 1999, the UK government implemented minimum wage legislation, increasing hourly wages to at least £3.60. This policy experiment created intervention and control groups that can be used to assess the effects of increasing wages on health. Longitudinal data were taken from the British Household Panel Survey. We compared the health effects of higher wages on recipients of the minimum wage with otherwise similar persons who were likely unaffected because (1) their wages were between 100 and 110% of the eligibility threshold or (2) their firms did not increase wages to meet the threshold. We assessed the probability of mental ill health using the 12‐item General Health Questionnaire. We also assessed changes in smoking, blood pressure, as well as hearing ability (control condition). The intervention group, whose wages rose above the minimum wage, experienced lower probability of mental ill health compared with both control group 1 and control group 2. This improvement represents 0.37 of a standard deviation, comparable with the effect of antidepressants (0.39 of a standard deviation) on depressive symptoms. The intervention group experienced no change in blood pressure, hearing ability, or smoking. Increasing wages significantly improves mental health by reducing financial strain in low‐wage workers. © 2016 The Authors. Health Economics published by John Wiley & Sons Ltd.

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Section: Introductionmentioning

confidence: 97%

Introduction of a National Minimum Wage Reduced Depressive Symptoms in Low-Wage Workers: A Quasi-Natural Experiment in the UK

et al. 2016

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“…Determining whether associations are causal is central to much addiction research but is challenging, with many observational associations unlikely to reflect causal relationships [1]. Randomized controlled trials (RCTs), which support stronger causal inference, are not suited to all research questions-particularly as their external validity may be limited [2][3][4]. Randomizing long-term behaviours or environmental exposures in humans is unethical and impractical.…”

Section: Introductionmentioning

confidence: 99%

Assessing causal relationships using genetic proxies for exposures: an introduction to Mendelian randomization

et al. 2017

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Background and aimsStudying the consequences of addictive behaviours is challenging, with understanding causal relationships from observational data being particularly difficult. For example, people who smoke or drink excessively are often systematically different from those who do not, are less likely to participate in research and may misreport their behaviours when they do. Furthermore, the direction of causation between an addictive behaviour and outcome may be unclear. Mendelian randomization (MR) offers potential solutions to these problems.MethodsWe describe MR's principles and the criteria under which it is valid. We identify challenges and potential solutions in its application (illustrated using two applied examples) and describe methodological extensions in its application.ResultsMR is subject to certain assumptions, and requires the availability of appropriate genetic data, large sample sizes and careful design and conduct. However, it has already been applied successfully to the addiction literature. The relationship between alcohol consumption (proxied by a variant in the ADH1B gene) and cardiovascular risk has been investigated, finding that alcohol consumption increases risk, with no evidence of a cardioprotective effect at moderate consumption levels. In addition, heaviness of smoking (proxied by a variant in the CHRNA5‐A3‐B4 gene cluster) and risk of depression and schizophrenia have been investigated, with no evidence of a causal effect of smoking on depression but some evidence of a causal effect on schizophrenia.ConclusionsMendelian randomization analyses are already producing robust evidence for addiction‐related practice and policy. As genetic variants associated with addictive behaviours are identified, the potential for Mendelian randomization analyses will grow. Methodological developments are also increasing its applicability.

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“…We aim to break the apparent indifference of economists to an ethical concern that is key for medical experimentation. In line with Baele (2013) and Petticrew et al (2013) who advocate the development of "social equipoise," this paper intends to initiate an equipoise conversation within the economic RCT community.…”

Section: Introductionmentioning

confidence: 91%

Ethics of Randomized Controlled Trials: Should Economists Care about Equipoise?

Abramowicz

Szafarz

2019

SSRN Journal

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Equipoise is defined by Freedman (1987, p.141) as a "state of genuine uncertainty on the part of the clinical investigator regarding the comparative therapeutic merits of each arm in a trial." This principle is grounded in the ethical motivation that any ex-ante preference for a given option would undermine the interests of those who are offered another. Randomized controlled trials (RCTs) in development economics disregard the equipoise requirement by typically disadvantaging the control group. This paper investigates how the equipoise principle is formalized in the medical literature and discusses whether and how it should be taken into consideration by economists. It argues that equipoise is especially relevant when double (or even single) blindness is excluded and when the control group includes already vulnerable individuals. More generally, this paper advocates for developing a vibrant ethics conversation on the design and fairness of RCTs in social sciences.

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In search of social equipoise

Cited by 23 publications

References 20 publications

Introduction of a National Minimum Wage Reduced Depressive Symptoms in Low-Wage Workers: A Quasi-Natural Experiment in the UK

Introduction of a National Minimum Wage Reduced Depressive Symptoms in Low-Wage Workers: A Quasi-Natural Experiment in the UK

Assessing causal relationships using genetic proxies for exposures: an introduction to Mendelian randomization

Ethics of Randomized Controlled Trials: Should Economists Care about Equipoise?

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