Call for randomised criminal-justice trials

October 14, 2004

A scientific approach to test the validity of criminal-justice interventions before they become implemented is proposed by the author of a Viewpoint in this week's issue of THE LANCET. The article provides details of how court-based randomisation could be put into practice.

Sheila Bird (UK Medical Research Council/University of Strathclyde, Scotland) focuses on the lack of true scientific evidence that has been used as a basis for implementing UK criminal justice policy on drug-dependent offenders. She outlines the ideal scientific approach for the criminal justice system: "Formal experiments, including the randomisation of sufficient numbers of offenders, are needed to inform judicial approval or "licensing" of new criminal-justice disposals before they are implemented nationally.

'Like doctors, judges should have access to studies comparing salient outcomes in large numbers of eligible drug-dependent offenders who have been randomised between drug treatment and testing order and alternative sentence. Judges have been criticised for unacceptable sentence variation, yet they are denied a rigorous evidence base to inform judicial decisions. Basing the management of offenders on inferior study designs that are non-randomised and underpowered denies them and us evidence about the efficacy and cost-effectiveness of new criminal-justice interventions. For example, punitive random mandatory drugs testing of prisoners has not been demonstrated to reduce inmates' use of heroin but had cost over UK£100 million when the UK's home affairs select committee called for its review in 2000."

Professor Bird adds: "Failure to randomise from the outset, or after pilot studies, means that, more than £100 million and 21 000 drug treatment and testing orders later, UK criminal justice still does not know whether such orders are safe, effective, and cost effective. We know their cost, but not their value. In 2004-05, less costly and intensive orders will be introduced, again without formal experimentation. It is time to end the masquerading of qualitative, implementation studies as outcome evaluations".

Potential solutions to the status quo include the creation of databases for drug-dependent offenders and the randomisation of offenders to a particular programme (eg, drug rehabilitation versus prison sentence) in the court room.

Professor Bird concludes: "We still lack answers to major questions: do such orders prevent drugs-related deaths, do they reduce incarceration days, reconviction rate, or unemployment days? The proposed court-based randomisation, designed to capture prescribed drug treatment and testing order and alternative sentence by court location, injector history, and crime type, would improve vastly on the current indiscipline of data...Because criminal justice deals with damaged as well as damaging young lives, it affects the public and offenders' health. Ignorance also damages wealth: the implementation of criminal-justice initiatives of uncertain efficacy and cost-effectiveness may be at the expense of fewer medicines-of known efficacy and cost-effectiveness-being prescribed by the UK National Health Service."
-end-
Contact: Professor Sheila M Bird, MRC Biostatistics Unit, Institute of Public Health, University Forvie Site, Robinson Way, Cambridge, CB2 2SR, UK; T) 44-122-333-0368 or 44-780-063-9269; sheila.bird@mrc-bsu.cam.ac.uk

ISSUE: 16-22 October 2004

Lancet

Related Drug Treatment Articles from Brightsurf:

New drug candidate for the treatment of COVID-19
Researchers from the University of Kent, the Goethe-University in Frankfurt am Main (Germany), and the Hannover Medical School (Germany) have identified a drug with the potential to provide a treatment for COVID-19.

Potential drug treatment for particular type of lung-cancer
Researchers at Kanazawa University report in Nature Communications the mechanism making some lung-cancer patients resistant to the drug osimertinib.

Cheap drug may alleviate treatment-resistance in leukemia
A common and inexpensive drug may be used to counteract treatment resistance in patients with acute myeloid leukemia (AML), one of the most common forms of blood cancer.

Recurrent miscarriage: Diabetes drug could lead to new treatment
A drug designed to tackle diabetes could also be repurposed as the first treatment to prevent miscarriage by targeting the lining of the womb itself, according to a clinical trial led by the University of Warwick.

Current treatment for fungal meningitis is fueling drug resistance
A common first-line treatment approach for cryptococcal meningitis in low-income countries is being compromised by the emergence of drug resistance, new University of Liverpool research warns.

New treatment to tackle drug-resistant strains of TB could now be possible
New drugs to treat strains of TB which have become resistant to treatment are now a possibility following a groundbreaking discovery from the University of Surrey.

Improving drug delivery for brain tumor treatment
Despite improvements in drug delivery mechanisms, treating brain tumors has remained challenging.

Investigational drug for people with treatment-resistant epilepsy
Imagine not being able to drive, shower alone or even work because you are never quite sure when the next seizure will leave you incapacitated.

A new drug could revolutionize the treatment of neurological disorders
The international team of scientists from Gero Discovery LLC, the Institute of Biomedical Research of Salamanca, and Nanosyn, Inc. has found a potential drug that may prevent neuronal death through glucose metabolism modification in stressed neurons.

When drug treatment for social anxiety is insufficient
A Japanese study group clarified that cognitive therapy maintained its effects more than a year after the end of therapy for patients with a social anxiety disorder even for those who did not respond to antidepressant drugs.

Read More: Drug Treatment News and Drug Treatment Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.