Neither guinea pigs nor sacrificial lambs, but pointers to better health care

Patients rightly worry that they risk being sacrificed in randomised trials whose results cannot be applied by clinicians in the front lines of real clinical practice. In a recent US survey, half the public considered trial participants to be “guinea pigs.” Altruistic goals such as “making a contribution to science” were judged far more likely to be achieved than personal benefits such as “getting the best possible treatment” or “having access to the best physician.”1 At the same time, many clinicians worry that the imposition of rigorous trial conditions on highly selected patients, especially in tertiary care settings, generates results that cannot be generalised to routine clinical practice.2

For the most part, these concerns originated from, and are perpetuated by, the examination of single trials or highly selective collections of them. Reports of the ghastly abuse of trial participants are sufficiently frequent and well publicised that they cause some to question …