It's not just that poorly designed and improperly analyzed clinical trials can directly lead to patient harms...they also delay otherwise attainable patient benefits. Just think of the progress we could make if everyone thought about it like this.

Importantly, the main reasons why we so often run sub-optimal trials have little to do with our personal desires. I'm sure everyone wants to do the best job possible. The real problem is that trials are not simple (despite what some would have you believe).

They are not simple to design. They are not simple to analyze. And they are for damn sure not simple to conduct. Consequently, good trials require support infrastructure. They require input from a variety of experts.

And the simple truth, as hard as it may be to accept, is that most trials conducted without these supports are just research cosplay.

Now I know most investigators are as frustrated with this as I am. I know they want to do a good job, but if you are required to conduct research to progress in your career, and don't have access to good support, there really isn't much that you can do.

This is why it is imperative for funders and universities to directly support clinical research infrastructure, even at the expense of funding for individual projects and investigators; and for clinical research leaders to demand that this infrastructure is in place. Thx!