Case reports: More than enough evidence

Abstract

Case reports, unlike randomized trials, are simply records of what actually happened -in the office, the clinic, or the hospital. They are chance events that we seek to understand and explain. They are fairly easy to write up, and do not require a lab, a research budget, or an administrator: "All you need," wrote one of my medical students, "is a patient and an observation." 1 Randomized trials, on the other hand, are carefully choreographed research enterprises that seek to answer specific questions about medicines or treatments under carefully controlled conditions. Randomized trials may be ingeniously constructed, but they are not creative. Case reports are fresh, speculative, hypothetical, and innately creative because they must try to explain the unexpected. The observations and hypotheses brought forth in case reports and case series supply many of the questions that randomized trials seek to answer. Case reports are exploratory; randomized trials are confirmatory. The case report vindicates the role of chance in the advance of knowledge.

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