Randomized Controlled Trials in Environmental Health Research: Unethical or Underutilized?

Abstract

Efficacious environmental interventions are needed because environmental risks account for a large fraction of the global disease burden. N Randomized controlled trials have not been widely embraced by environmental health researchers and comprise less than 1% of research publications in the field. N Additional randomized controlled trials in environmental health would complement a strong tradition of observational research by creating new knowledge on exposure–health relationships, providing more definitive evidence of causality, identifying efficacious interventions to reduce or eliminate hazards, and countering the perception that environmental risks are evaluated with inadequate rigor. N Ethical issues—including clinical equipoise, the distribution of benefits and risks, and the relevance of the intervention and health outcome to the study population—must be carefully considered before conducting a randomized controlled trial of an environmental intervention.