Clinical trials: what more is needed? A critical view

TRADITIONAL DIVISIONS OF MEDICAL RESEARCH: Medical research has been traditionally classified as "basic' and "applied'. The latter category has tended to emphasize the value of randomized controlled trials. These, however, cannot be applied to routine clinical care without considerable extrapolation. There is a further need for research into optimal methods of health care delivery directed at improving the standards of treatment and taking account of such factors as socio-economic need and barriers to access. REQUIREMENT FOR AN INTEGRATED PROGRAMME OF RESEARCH: If the full opportunities offered by scientific research are to be exploited, an integrated programme of research is required which extends from the basic to the applied and which recognizes the traditional, end-point, controlled trial as only one component in a spectrum of scientific activity.