McGoey Linsey
Univ. of Oxford.
Hist Human Sci. 2010;23(1):58-78. doi: 10.1177/0952695109352414.
Drawing on an analysis of Irving Kirsch and colleagues' controversial 2008 article in "PLoS [Public Library of Science] Magazine" on the efficacy of SSRI antidepressant drugs such as Prozac, I examine flaws within the methodologies of randomized controlled trials (RCTs) that have made it difficult for regulators, clinicians and patients to determine the therapeutic value of this class of drug. I then argue, drawing analogies to work by Pierre Bourdieu and Michael Power, that it is the very limitations of RCTs -- their inadequacies in producing reliable evidence of clinical effects -- that help to strengthen assumptions of their superiority as methodological tools. Finally, I suggest that the case of RCTs helps to explore the question of why failure is often useful in consolidating the authority of those who have presided over that failure, and why systems widely recognized to be ineffective tend to assume greater authority at the very moment when people speak of their malfunction.
基于对欧文·柯施及其同事2008年发表在《公共科学图书馆杂志》上关于如百忧解等选择性5-羟色胺再摄取抑制剂（SSRI）抗抑郁药物疗效的有争议文章的分析，我审视了随机对照试验（RCT）方法学中的缺陷，这些缺陷使得监管机构、临床医生和患者难以确定这类药物的治疗价值。然后，我通过类比皮埃尔·布迪厄和迈克尔·鲍尔的研究成果进行论证，指出正是随机对照试验的局限性——它们在产生可靠临床疗效证据方面的不足——反而有助于强化人们认为它们作为方法学工具具有优越性的假设。最后，我提出随机对照试验的案例有助于探讨这样一个问题：为什么失败往往有助于巩固那些主导失败的人的权威，以及为什么那些被广泛认为无效的系统在人们谈及它们的故障时往往会获得更大的权威。
