From therapeutic trials to current practice

Ideally, there is continuous interaction between clinical reality and the m ethods of controlled clinical trials. The design of a proper trial ought to reflect the physician's and especially the patient's point of view, and co nversely a familiarity with clinical trials,improves the methods of daily p ractice. In other words, every methodological principle is rooted in clinic al practice. Some examples are: randomisation (with constructive doubt as i fs practical equivalent), independence (a healthy mistrust of drug companie s), informed consent (sharing uncertainty with patients), type I error (no false optimism after a single trial), type II error (no false pessimism aft er a single trial), choosing the right measure of outcome (relevance outwei ghs precision), the intention-to-treat principle (pragmatic analysis), and the dangers of subgroup analysis (the "my-last-patient syndrome").