PLOS Medicine: Why Most Clinical Research Is Not Useful (John P. A. Ioannidis)

PLOS Medicine (open access)

June 21, 2016 

 Conclusion

Overall, not only are most research findings false, but, furthermore, most of the true findings are not useful. Medical interventions should and can result in huge human benefit. It makes no sense to perform clinical research without ensuring clinical utility. Reform and improvement are overdue.

 Summary Points

• Blue-sky research cannot be easily judged on the basis of practical impact, but clinical research is different and should be useful. It should make a difference for health and disease outcomes or should be undertaken with that as a realistic prospect.
• Many of the features that make clinical research useful can be identified, including those relating to problem base, context placement, information gain, pragmatism, patient centeredness, value for money, feasibility, and transparency.
• Many studies, even in the major general medical journals, do not satisfy these features, and very few studies satisfy most or all of them. Most clinical research therefore fails to be useful not because of its findings but because of its design.
• The forces driving the production and dissemination of nonuseful clinical research are largely identifiable and modifiable.
• Reform is needed. Altering our approach could easily produce more clinical research that is useful, at the same or even at a massively reduced cost.

Table 1. Features to consider in appraising whether clinical research is useful.

http://dx.doi.org/10.1371/journal.pmed.1002049.t001

Features of Clinically Useful Research:

Problem Base

Context Placement and Information Gain

Pragmatism

Patient Centeredness

Value for Money

Feasibility

Transparency (Trust)

Other Considerations:

Uncertainty

Other sources of evidence besides trials

Focusing on major journals

Overall Picture

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