Intended for healthcare professionals

Editorials Christmas 2017

Big Science for patient centred care

BMJ 2017; 359 doi: (Published 08 December 2017) Cite this as: BMJ 2017;359:j5600
  1. Victor M Montori
  1. Mayo Clinic, Rochester, MN, USA
  1. montori.victor{at}

Only massive and fearless collaboration can produce evidence that works for patient care

Advancing the problematic situation of patients requires clinicians and patients to draw from their experience, expertise, and evidence. Working together, they should be able to identify a way forward that makes intellectual, emotional, and practical sense.1 How research is conducted, however, offers challenges to achieving patient centred care. The solution may lie in Big Science.

Little Science

For many situations, funders prefer to obtain answers efficiently, and researchers win the competition for resources when they propose the smallest and briefest study. To succeed, these Little Science trials must enrol high risk patients, use comparators that favour the experimental intervention, and use responsive endpoints—surrogate or composite endpoints. Hiding unflattering results completes the illusion. Clinicians and patients must deal with imprecise, inconsistent, and incomplete results about the effect of impertinent comparisons on endpoints of unclear relevance to the experience and destiny of patients. Little Science may work to support …

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