We need to know whether drugs and other healthcare treatments work. The field of evidence-based medicine developed important tools, like randomised controlled trials, to do this. While they have helped drive huge advances in medical science, we should be cautious about relying solely on trials to evaluate new healthcare interventions. Although valuable, they can be misleading if badly designed, and they aren’t intrinsically superior to all other evidence. Evidence-based medicine should use real-life observations alongside trial data to get richer and more accurate answers for patients.If you had enough of a potentially life-saving drug for half the patients with a deadly disease but not enough for all of them, how would you decide whom to treat? Would you flip a coin? Allocate sequentially (patient 1 gets the treatment, patient 2 nothing, and so on)? Write ‘drug’ or ‘no drug’ on hundreds of cards, put them in identical sealed envelopes and shuffle thoroughly …

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