Patients in control groqps assigned to receive standard treatment in therapeutic clinical trials tend to fare better than otherwise similar patients treated with best practice alone, irrespective of any effect in the active comparator group [1]. One reason may be that such patients benefit from the discipline imposed by a formal protocol with specified follow-up, monitoring and so on, although additional factors no doubt contribute as well. This is one reason why we support enrolment of patients into such trials, when a suitable study is available-[2]. When no suitable clinical trial is available,formal checklists [3] and treatment guidelines offer some of the discipline of a trial protocol. Do they deserve three cheers? That depends on the quality of the guideline, individual aspects of the patient and their disease and the thoughtfulness and medical decision making/therapeutic skills of the clinician.
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