Clinical trials for tomorrow funded by the MRC

Future policy report raises several unanswered questions

The Medical Research Council has an honourable tradition of supporting high quality randomised controlled trials. It funded one of the most celebrated early trials—of streptomycin for pulmonary tuberculosis, published in the BMJ in 1948.1 It has just published a commendably short 12 page report to determine its future policy and approach to randomised controlled trials2—so what does it say?

It is encouraging that the MRC intends to promote trials of so called complex interventions, where several components act both independently and interdependently. This is precisely where substantial methodological challenges are to be tackled—just what is the intervention, what outcomes are relevant, and how can the results be generalised to clinical practice? For example, the results of a trial of care in a stroke unit compared with care in a general medical ward must depend on the nature of the stroke unit and general medical ward being compared—their staffing, treatment policies, duration of admission, and so on. But although ring fenced funding for the development stage of such trials is welcome, the allocation of £250 000 ($405 000; €352 000) annually will hardly be enough to put trial proposals “on a more even footing with those involving drugs.” After all, the pharmaceutical companies spend millions to get …