The editorial addresses issues which are well known and well recognized as deserving urgent attention. In singling out surgical trials, the author does seem to be 'biased'! The solutions that the author has proposed have also been spelled out many a times previously. There is nothing 'new' in what the author proposes. This is similar to what most of the trials that we participate in do. They validate previous trials. Some of them just end up making attempts to validate never reaching the final stages of trial completion. The reasons may be varied, from attrition in the original team to lack of continued funding, or sometimes just a change in the institution management. So to characterize 'failed' trials as a waste of resources is a bit cruel. No researcher starts a study with the intention of failing or not completing it.
The increased number of trials are just a reflection of the changing times. In the past few decades there has been an explosion in the number of medical researchers. The modern times have given the Physician a luxury - of being able to concentrate on non-clinical pursuits - because of the increased numbers of doctors, better infrastructure and more funding opportunities. No longer do we have only islands of research, located in capitals and populated by a select few. Research has actually been democratized. In the present times, a resident can dream of writing a research proposal and also hope for funding. Was this possible a few decades ago?
The invention of movable press was supposed to drown us in smut and literature of such poor quality that we would be left just pandering to our baser instincts. But the same tool - the movable press - also enabled a much wider distribution of all knowledge. And so is RCT - a tool. And ultimately it is up to the artist to use the tool as he wishes. In the millions of trials that have been and are being done, there will be ones which will change paradigms. But we will never be able to select for those trials beforehand. Their utility will only be recognized in hindsight. The issue of allocation of resources is as old as mankind. Lets not make it the only issue of concern. For every unsuccessful, unpublished trial there are students who will learn new skills through participation. Researchers at a personal level learn how not to do things. As Arthur Clarke wrote - The toolmakers had been remade by their own tools.
So lets not abandon our pursuit of truth - for this is what all RCTs are - and on the way if we discover a few new things or find few old lies being presented as the truth, then so be it.
Rapid Response:
Re: Clinical trials: what a waste
The editorial addresses issues which are well known and well recognized as deserving urgent attention. In singling out surgical trials, the author does seem to be 'biased'! The solutions that the author has proposed have also been spelled out many a times previously. There is nothing 'new' in what the author proposes. This is similar to what most of the trials that we participate in do. They validate previous trials. Some of them just end up making attempts to validate never reaching the final stages of trial completion. The reasons may be varied, from attrition in the original team to lack of continued funding, or sometimes just a change in the institution management. So to characterize 'failed' trials as a waste of resources is a bit cruel. No researcher starts a study with the intention of failing or not completing it.
The increased number of trials are just a reflection of the changing times. In the past few decades there has been an explosion in the number of medical researchers. The modern times have given the Physician a luxury - of being able to concentrate on non-clinical pursuits - because of the increased numbers of doctors, better infrastructure and more funding opportunities. No longer do we have only islands of research, located in capitals and populated by a select few. Research has actually been democratized. In the present times, a resident can dream of writing a research proposal and also hope for funding. Was this possible a few decades ago?
The invention of movable press was supposed to drown us in smut and literature of such poor quality that we would be left just pandering to our baser instincts. But the same tool - the movable press - also enabled a much wider distribution of all knowledge. And so is RCT - a tool. And ultimately it is up to the artist to use the tool as he wishes. In the millions of trials that have been and are being done, there will be ones which will change paradigms. But we will never be able to select for those trials beforehand. Their utility will only be recognized in hindsight. The issue of allocation of resources is as old as mankind. Lets not make it the only issue of concern. For every unsuccessful, unpublished trial there are students who will learn new skills through participation. Researchers at a personal level learn how not to do things. As Arthur Clarke wrote - The toolmakers had been remade by their own tools.
So lets not abandon our pursuit of truth - for this is what all RCTs are - and on the way if we discover a few new things or find few old lies being presented as the truth, then so be it.
Competing interests: No competing interests