Clinical Trials and the Reorganization of Medical Research in post-Second World War Britain

Abstract

The rise of biomedicine is usually associated with the transformation of biological and medical research in the United States following the vast expansion of funding, both private and public, in the years after the Second World War. 1 Along with the other authors in this issue, we are interested in describing this phenomenon in national contexts other than the United States. Our discussion of biomedicine in Britain draws upon many of the same themes as our fellow authors and the existing literature on the US-the new role of the state as scientific entrepreneur; the relationship between experimental medicine and clinical services; and the growing institutionalization of associations between laboratory and clinic-to emphasize the clinical trial as a privileged form of therapeutic evaluation in the post-war years. In particular we are keen to stress that the randomized clinical, or controlled, trial (RCT) in Britain developed within a period of increasing centralization of state policy and planning for health services and medical research.The epistemological success of the RCT in demonstrating the value of the antituberculosis drug streptomycin elevated the technique to international prominence in the late 1940s. The 1948 trials of streptomycin conducted by the British Medical Research Council (MRC), along with similar trials in the United States, are usually recognized as the world's first randomized controlled trials. Indeed, the streptomycin trials, and the trials of PAS and isoniazid that followed in the early 1950s, did combine the statistical technique of randomization, with new organizational techniques, such as the division of specialist labour, and central review and data collection, across multiple sites of study. As Peter Keating and Alberto Cambrosio, Ilana Löwy, and Harry Marks have shown for the US, the success of the co-operative (that is, multi-centre) clinical trial was intimately related to the new role of the federal government, through

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