We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......

Randomized Clinical Trials Need to Be More Clinical

Peter P. Morgan, MD
JAMA. 1985;253(12):1782-1783. doi:10.1001/jama.1985.03350360108031.
Text Size: A A A
Published online


It is tempting to despair that scientific conditions can ever be substituted for clinical circumstances. Randomized trials were first developed for agricultural research in an attempt to account for the natural variability in plots of ground and species. The results of those trials have been used to produce consistent increases in crop yields.1

While random allocation of treatments and isolation of variables appear natural in agriculture, it can be an invasive procedure in clinical medicine. The randomized clinical trial requires clinicians to set aside their own judgments, asks patients to accept a treatment that may be substandard, introduces arbitrary definitions of disease, encourages recruitment of patients, and requires aggressive follow-up and unusual efforts to ensure compliance. But the clinical milieu is complex and refractory; seldom does the randomized clinical trial succeed in eliminating or bypassing "extraneous" clinical variables.

More than two years after the publication of the β-blocker heart


Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?




Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.