Toward more definitive clinical trials

The randomized clinical trial is an essential evaluation tool in the health care field. Unfortunately, the majority of trials performed have too few patients to reach a conclusion regarding the treatments under study. In many instances, the multicenter trial represents the only way to obtain the necessary numbers. Such trials are difficult to organize and costly to carry out, but they have strengths not found in the ordinary single center trial. The multiplicity of disciplines required usually leads to better design and more careful execution than can be achieved with the resources of a single center. The heterogeneity of the population and multiplicity of clinics applying the study treatments provide a more realistic test of the therapies in question than is possible in a single clinic. Sponsors of trials need to stimulate more research into the methodology of multicenter trials, including investigation of the methods of organizing and carrying out such trials in a cost-effective manner. In addition, a communications network should be developed to promote the field of clinical trials as a discipline and to facilitate the identification and dissemination of information on their design and conduct.