Is this the end of research as we know it?

BMJ 1997; 315 doi: (Published 16 August 1997) Cite this as: BMJ 1997;315:383

Stephen Proctor has pioneered an innovative research method involving whole populations. He tells Adam Legge why this approach, rather than randomised controlled trials, is the way forward

Professor Proctor ruffles the feathers of the orthodoxy


If you want to set up a trial looking at a disease of comparatively low incidence then current thinking demands you do a multicentre randomised controlled trial. You set up a protocol, send it round, and hope other clinicians will join up. With luck you might get up to a third of the patients in the country.

Of course there will be an element of selection, and patients in another centre are unlikely to be managed exactly in the same way as yours. There will be patients you can't include, such as those who are too old or have atypical disease. They will not be included and therefore their progress will not be tracked.

This, according to Stephen Proctor, is just not good enough. He is professor of haematological medicine at the Royal Victoria Infirmary in Newcastle and is arguably the leading voice challenging megatrials as the gold standard for studying disease, in his case haematological malignancies. His alternative has been to develop …

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