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If it is about allocations of money to qualitatively different health interventions, then that should be the randomization, if indeed it is possible. If there is little doubt about the efficacy of a given allocation, or intervention, it probably shouldn't be randomized against not giving that intervention, although that depends on background conditions. Randomization to a suboptimal state can be justified depending on the counterfactual in that area. There is something to be learned from the thinking that has gone on in medicine, but it has to be correctly framed. But the better medical parallel to development is the area of systems or quality improvement, which even in medicine can be very context-dependent. Although I would alter the order of reactions above and give a slightly different angle to the arguments. So any design (RCT or not) that leaves subjects without treatment in presente of 'clinical equipoise' would be un ethical. In this situation, as Clomifene Citrate pills reminds us, RCT can be the most fair way of assigning treatment, given that after applying all reasonable targeting criteria, a lottery gives everyone the same chance. I have 2 questions though: a) Say I have 3 equally costly competing treatments that aim to meet a common social objective. If I can apply 'clinical Clomifene Citrate on reddit to one of them and not to the other 2 would this not imply that the equipoise one is better than the others. If it was only the former, I think your cost effectiveness and alternative cost argument is stronger. If it was also de later, I we could think of cost effectiveness comparisons and ranking without any experiment given that I would know the magnitud of the cost, the direction of impact, and also the magnitude of impact. Having said this, a last question: In reality is it common to face 'clinical equipoise' in development economics. I agree its fair to consider this concept while prioritizing questions to answer, but does this not happen implicitly in academia.

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