The need to facilitate clinical research is widely recognised1 2—particularly translational “bench-to-bedside” research and randomised controlled trials of interventions. Indeed, the influential report of the Academy of Medical Sciences on Strengthening Clinical Research concentrated purely on these two areas.2 However, there is another even more neglected field of clinical research, which arguably has greater potential to improve clinical outcomes, certainly in the short term: basic observational research necessary for effective clinical practice.

It is common to find, for example, that although much is known about the molecular pathology of a condition, little is known about the reliability of clinical diagnosis, or about prognosis and the factors that affect it. Yet, these issues are of most concern to patients and clinicians: How certain can you be about the diagnosis, doctor? What are the risks of a poor outcome over the next few weeks/months/years? How do my particular characteristics influence the likely outcome? The trial showed that this treatment is likely to do more good than harm on average, but are the risks worth taking in my case?

The report by …