Every prescription is a clinical trial

doi:10.1136/bmj.329.7478.1346

BMJ 2004;329:1346 (4 December), doi:10.1136/bmj.329.7478.1346

Letter

Every prescription is a clinical trial

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

EDITOR—Senn questions whether individual response to treatmentis a valid assumption.¹ Patients have never responded consistentlyto treatment, and, additionally, every time a prescription iswritten (except for identical twins) what effectively beginsis a clinical trial with n = 1.

Evidence based medicine or evidence based clinical practiceis the judicious application of best current knowledge to thecondition and values of each patient.² It should therefore allowfor individualised treatment, which may entail a drug differentfrom the "best" identified after systematic review. Can thegold standard randomised controlled trial really deliver thedesired certainty when identifying which patients will respondto the treatment is impossible?

Trials organised by pharmaceutical companies are designed toshow the superiority of a company's product over a competitor'sto ensure optimum market share, with little thought for theindividual patient receiving the drug. Promotion follows toensure product recognition at . . . [Full text of this article]

Alfred P J Lake, consultant in anaesthesia and pain management

Glan Clwyd Hospital, Rhyl, Clwyd LL18 5UJ apjlake@aol.com