Clinical outcomes depend on treatment AND other factors:  underlying severity of illness, comorbid conditions, and other prognostic factors that may be unknown.  Randomization ensures treatment is only factor affecting difference in outcome between two groups in the study.

Factors affecting clinical outcome also influence investigators decisions to enroll in the treatment group.  What result does the researcher want?

Nonrandomized studies tend to show larger (usually false positive) treatment effects than do randomized trials.