‘Pragmatic’ Clinical Studies are the Way Forward

As a clinician it is near impossible to compare drugs based purely on EBM. Even the best meta-analysis is only a compilation of lesser studies that are, at best, equal comparisons of several treatment types. The real world use of a drug is almost always different, not least because your population in the clinical study may differ to the people you are treating. Hence the need for pragmatic studies.

Pragmatic clinical studies are essentially ‘real-world’ analyses of drugs and require a major shift in the way we approach pharmaceutical science.

The New York Times , in an occasional series called “The Evidence Gap,” examined the “growing movement” among researchers to conduct pragmatic clinical trials to gather evidence “that will fill some of the biggest gaps in medical science: What treatment is best for typical patients with complex symptoms?” According to the Times, “thousands of medical studies are completed every year,” but “most have relatively limited goals.” The Times reports that while such limited studies “can have value,” they “may no longer be enough, particularly when care has become so expensive and real evidence more crucial.”

A group of advocates is lobbying the US congress to provide funds for an Institute for Comparative Effectiveness Research, which would assess treatments and identify evidence gaps. The center also would initiate pragmatic studies.