BMJ 1998;317:1170-1171 ( 31 October )

Editorials

Trials: the next 50 years

Large scale randomised evidence of moderate benefits 

The first 150 words of the full text of this article appear below.

Over the past half century there has been a vast proliferation first of randomised trials and now of meta-analyses, both of which (if appropriately analysed) can avoid bias. But to get medically reliable answers to previously unanswered questions about life or death treatment decisions it isn't enough just to avoid bias. We must also ensure that we are not seriously misled by the play of chance, and often the only way to do this reliably is to get appropriate analyses of really large scale randomised evidence.¹

At present, many wrong, or at least unreliable, therapeutic answers are being generated by non-randomised "outcomes research," by small randomised studies, by small meta-analyses, and by statistically inappropriate analyses. Moreover, even when large scale randomised evidence is available, wrong conclusions can be drawn from unduly selective emphasis on particular trials or subgroupsand such "selection biases" can cause even greater errors when there is . . . [Full text of this article]

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Rapid Responses:

Read all Rapid Responses

Large scale trials exacerbate risk of spurious conclusion if bias is not eliminated

D B Double
bmj.com, 5 Nov 1998 [Full text]

Drug Development is Different

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bmj.com, 6 Nov 1998 [Full text]

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bmj.com, 4 Dec 1998 [Full text]