Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
To the Editor: Dr Tunis and colleagues1 discussed the need for practical clinical trials
(PCTs) to better meet the information needs of clinical and health policy
decision makers. While there is a growing need for rigorous effectiveness
studies, we doubt that such studies alone will be sufficient. First, the conduct
of PCTs will not ensure that evidence is translated into clinical practice.
The poor translation of evidence into practice is illustrated by numerous
examples of suboptimal quality of care despite high-quality evidence.2 Second, despite the presence of rigorous economic
studies, efficiency and cost-effectiveness are infrequently incorporated into
clinical practice guidelines.3 Third, clinical
practice guidelines require significant effort for implementation, yet few
health care settings have the necessary infrastructure. Rigorous effectiveness
trials will be of little benefit until these issues are addressed.
Ofman JJ, Lubeck DP. Realizing the Benefits of Practical Clinical Trials. JAMA. 2004;291(4):425-426. doi:10.1001/jama.291.4.425-b