Are Randomized Poverty-Alleviation Experiments Ethical?

Peter Singer et al at Project Syndicate: “Last month, the Nobel Memorial Prize in Economic Sciences was awarded to three pioneers in using randomized controlled trials (RCTs) to fight poverty in low-income countries: Abhijit Banerjee, Esther Duflo, and Michael Kremer. In RCTs, researchers randomly choose a group of people to receive an intervention, and a control group of people who do not, and then compare the outcomes. Medical researchers use this method to test new drugs or surgical techniques, and anti-poverty researchers use it alongside other methods to discover which policies or interventions are most effective. Thanks to the work of Banerjee, Duflo, Kremer, and others, RCTs have become a powerful tool in the fight against poverty.

But the use of RCTs does raise ethical questions, because they require randomly choosing who receives a new drug or aid program, and those in the control group often receive no intervention or one that may be inferior. One could object to this on principle, following Kant’s claim that it is always wrong to use human beings as a means to an end; critics have argued that RCTs “sacrifice the well-being of study participants in order to ‘learn.’”

Rejecting all RCTs on this basis, however, would also rule out the clinical trials on which modern medicine relies to develop new treatments. In RCTs, participants in both the control and treatment groups are told what the study is about, sign up voluntarily, and can drop out at any time. To prevent people from choosing to participate in such trials would be excessively paternalistic, and a violation of their personal freedom.

less extreme version of the criticism argues that while medical RCTs are conducted only if there are genuine doubts about a treatment’s merits, many development RCTs test interventions, such as cash transfers, that are clearly better than nothing. In this case, maybe one should just provide the treatment?

This criticism neglects two considerations. First, it is not always obvious what is better, even for seemingly stark examples like this one. For example, before RCT evidence to the contrary, it was feared that cash transfers lead to conflict and alcoholism.

Second, in many development settings, there are not enough resources to help everyone, creating a natural control group….

A third version of the ethical objection is that participants may actually be harmed by RCTs. For example, cash transfers might cause price inflation and make non-recipients poorer, or make non-recipients envious and unhappy. These effects might even affect people who never consented to be part of a study.

This is perhaps the most serious criticism, but it, too, does not make RCTs unethical in general….(More)”.