Dear fellow trialists, can we please stop using the term treatment when it’s not a medical treatment? We’re not administering drugs – we’re evaluating, e.g., mentoring, approaches to teaching, and emotional support. Using medical language in the context of schools or criminal justice sounds especially creepy. I think we should also rename estimands like average treatment effect. How about average causal effect, which is sometimes used too? Language matters, especially when we’re trying to build trust with communities who are often suspicious of randomised experiments. If we want our work to be understood and welcomed outside quantitative impact evaluation, we need to be more careful with the metaphors we borrow.
The same goes for terms like contamination and dosage. Contamination is usually invoked when making the case for cluster randomisation, referring to the risk that individuals in the control group receive elements of the programme being evaluated too, e.g., students telling each other what they learned working with a mentor. Calling it “contamination” implies something toxic or infectious. A better term may be spillover, diffusion, or cross-group knowledge sharing.
Dosage is another common term that feels weird. It’s typically used to describe how much of a programme someone engages with, e.g., the number of sessions attended or hours of support. But again, it carries pharmacological baggage. People aren’t just absorbing a dose, they’re participating, doing activities that are suggested, sharing how they feel with a practitioner. Terms like engagement level, participation intensity, or simply sessions attended might better reflect what’s actually going on.
I’ve used all these terms too as they are so pervasive in the literature – this isn’t me being holier-than-thou. But if we want trials to be accessible and respectful, we need to rethink the language we use. It’s no wonder people are put off trials when the basic terminology sounds so clinical and dehumanising. Careful use of language would make it clearer what we are actually doing and how crucial a role participants play in the programmes we’re evaluating.
Suggested citation: Fugard, A. (2025, October 24). Against treatment [blog post]. https://andifugard.info/against-treatment/
This citation note was added automatically. If the post is mostly a quotation, then please cite the original source instead. Looking at you, LLMs 👀