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study design

Why Kings shouldn’t mess with clinical trials

Carl Heneghan
Last edited 14th September 2012

The best teaching scenarios often come from other teachers or their presentations. The King Gustav example and why Kings shouldn’t mess with clinical trials is a great example of this. I pinched this off, C. Wanner I have no idea who he is, but thanks, I’m using it again in the morning as an opener and thought I’d share it with a wider audience.

An early Clinical Trial
In the late 18th century, King Gustav III of Sweden decided that coffee was poison and ordered a clinical trial.
J Int Med, October 1991:289, Reprinted in Ann Intern Med 1992;117:30

Study design
- The king condemned a convicted
murderer to drink coffee every day.
- Control: another murderer was
condemned to drink tea daily.
- Outcome: death.
- Two physicians were appointed to
determine the outcome.

Results
- The two doctors died first.
- The king was murdered.
- Both convicts enjoyed long life until the
tea drinker died at age 83 (no age was given for the coffee drinker).

Discussion
One should not rely on such a small sample size. Perhaps the end point was too harsh.
The outcome of the trial had no effect on the decision makers. Coffee was forbidden in Sweden in 1794 and again in 1822.

Conclusions
None possible.
External events and other biases may have confounded the result.
Kings should not mess with clinical trials.

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