Uncertainty Principle Versus Clinical Equipose in Clinical Trials in Sub -saharan Africa: Are They Really Tenable?

The argument for 'evidence based medical practice' is compelling and the ideal protocol of randomized controlled studies to obtain higher level evidence is equally sound. However, some peculiarities of African countries make the conduct of standard control trials difficult and raise some serious ethical questions over claims of good trial practices. It may be difficult to apply the uncertainty principle or clinical equipoise as moral underpins for randomization in clinical trials in Africa. A 'social contract' argument may be a useful alternative.