Protection of Random Assignment

Existence of an alternative explanation for the benefit of a treatment is a confounder. It is a nuisance “passenger” variable that rides along with treatment and undermines the ability to make causal inferences. This chapter focuses on why random assignment is so powerful and should be protected. It presents a history of attempts to answer the question of whether or not a treatment works, and the arrival at random assignment as the best way to make causal inferences about the benefits of a treatment. It defines confounding as an error of interpretation and the essential role of avoiding it by protecting the random assignment. It then goes on to illustrate ways to protect random assignment in the design, conduct, and analyses of a trial, with particular attention to the central role of identifying a patient-centered target population, recruiting it, retaining it, and insuring that all randomized participants are included in the evaluation of trial results.