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August 17, 2011

Efficacy Research and Unanswered Clinical Questions

Author Affiliations

Letters Section Editor: Jody W. Zylke, MD, Senior Editor.

Author Affiliations: Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada (Dr Vohra) (; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (Ms Shamseer); and Children's Hospital of Eastern Ontario, Ottawa (Dr Sampson).

JAMA. 2011;306(7):709-710. doi:10.1001/jama.2011.1150

To the Editor: Drs Djulbegovic and Paul argued that a growing number of important clinical questions are being left unanswered by efficacy research.1 For instance, patients with comorbid conditions and concurrent medications are largely excluded from clinical trials because they may dilute the observed treatment effect. However, these complexities are present in the majority, rather than a subset, of clinical populations.2 This evidence-practice gap has important consequences with respect to treatment effectiveness, patient safety, and allocation of scarce resources.

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