This trial design (randomized controlled trials) is considered the most robust and reliable. However, when I step onto my ICU tomorrow, 90 per cent of what I do will not be based upon this level of evidence. … Tomorrow I may examine all of my patients with my hands and my stethoscope but, surprisingly, there are few studies to support these as useful practices. If the stethoscope were to be invented today, it would most likely not meet the current standards needed for approval of a medical device. Yet they continue to be used due to tradition, culture and a feeling that research studies are not the only arbitrator of what it best.引自第125页
If you take part in a clinical trial, you are more likely to survive even if you only receive the placebo. If you are treated in a hospital that does research, you too are more likely to live than to die. The environments that nurture good research are also more likely to have good communication between staff, fewer vacancies and higher job satisfaction.引自第129页
This selective publishing should not be acceptable in medicine. The former editor of the British Medical Journal has argued that the entire medical journal industry should be disbanded. The powerful ‘all trials’ movement led by Dr Ben Goldacre aims to publicise these issues surrounding clinical-trial data loss, manipulation and concealment. 引自第131页
Critical
