Trial predictability and other stories . . .

Trials inevitably mean tribulations. Randomised controlled trials require effort and time, and their moral basis depends on genuine uncertainty about the value of the intervention being tested. A classic short paper in Nature (2013, doi:10.1038/500395a) by Djulbegovic and colleagues examines how often randomised controlled trials show that a new intervention is superior to its comparator. The researchers analysed 860 published and unpublished phase III trials performed by academics or pharmaceutical companies in six consecutive series of trials with a total of more than 350 000 patients. They found that new treatments were shown to be superior in around 50% of cases—just as one would predict from the principle of clinical equipoise. They conclude that “our retrospective view of more than 50 years of randomized trials shows that they remain the ‘indispensable ordeals’ through which biomedical researchers’ responsibility to patients and the public is manifested.”

While randomised controlled trials remain the best test of individual treatments, Minerva believes that …