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Commentary: View from the frontline of pragmatic trials

BMJ 2017; 357 doi: (Published 14 June 2017) Cite this as: BMJ 2017;357:j2837
  1. Ashley Woodcock, professor of respiratory medicine
  1. University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
  1. ashley.woodcock{at}

As long ago as 1998 Roland and Torgerson pointed out that efficacy and pragmatic trials sometimes arrive at different conclusions “either because a treatment that works in an ideal setting does not work in real life, or because improvement in a biomedical endpoint does not produce the expected health gain.”1 The highly controlled environment of randomised controlled trials designed to examine efficacy or safety does not reflect everyday practice. In trials of chronic obstructive pulmonary disease (COPD) or asthma, for example, primary efficacy endpoints are selected to give the …

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