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February 9, 2011

The Clinical Research Enterprise: Time to Change Course?

Author Affiliations

Author Affiliations: EviMed Research Group, Goshen, Massachusetts; School of Public Health and Health Sciences, University of Massachusetts, Amherst; and Jefferson School of Population Health, Thomas Jefferson University, Philadelphia, Pennsylvania.

JAMA. 2011;305(6):604-605. doi:10.1001/jama.2011.104

To keep up with the latest information, a physician needs to read 75 primary studies and 11 meta-analyses daily.1 Yet despite this avalanche of published research, solid evidence for everyday interventions remains scarce,2 and even available evidence has been called into question because of various ubiquitous threats to validity.3 As a result, despite the growth of available technologies and information, knowledge and understanding of the appropriate use of these tools is far from optimal. One possible manifestation of this lack of understanding is the death toll associated with medical interventions, particularly in hospitals. Iatrogenic events are the third leading cause of death in the United States,4 and unfortunately, despite a decade of focused interventions aimed at quality improvement in hospitals, these numbers have not changed.5 This is partly due to high barriers in the physician community to adoption of evidence-based practice guidelines,6 but other factors are likely at play. One such factor may be the paucity of individualizable evidence.

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