In reply
The purpose of medicine is only to promote human health. Clinical trials, which involve patients who generously donate their time and selves, cannot sometimes address clinically relevant questions; they must always be conducted in the interest of settling the most pressing open issues. Such trials alone meet the ethical demands of our profession1 and are desperately needed to sort out the numerous, high-cost practices in medicine—practices, whose continued, untested acceptance threatens both our patients' well-being and our economy.