Another brilliant write up! This was a commissioned article (an opinion) and has important takeaways.
There are many millions of papers of clinical research—approximately 1 million papers from clinical trials have been published to date, along with tens of thousands of systematic reviews—but most of them are not useful. Waste across medical research (clinical or other types) has been estimated as consuming 85% of the billions spent each year . I have previously written about why most published research is false  and how to make more of it true . In order to be useful, clinical research should be true, but this is not sufficient. Here I describe the key features of useful clinical research (Table 1) and the current state of affairs and suggest future prospects for improvement.
The questions that need to be asked:
That’s one reason we end up seeing a multiplicity of papers/trials/studies without a discernible benefit. The author has practical suggestions to change the situation. I think the most important takeaway is this:
The clinical research workforce is huge: millions of people have coauthored at least one biomedical paper, and most have done so only once . Students, residents, and clinical fellows are often expected to do some research. This exposure can be interesting, but trainees are judged on their ability to rapidly produce publications, a criterion that lends itself badly to the production of the sort of large, long-term, team-performed studies often needed to inform us about health, disease, and health care. Such researchers can become exploited as low-paid or volunteer personnel , and an untrained, noncommitted workforce cannot produce high-quality research. Other perverse recipes in clinical research include universities and other institutions simply asking for more papers (e.g., least publishable units) instead of clinically useful papers and clinical impact not being a formal part of the publication metrics so often used to judge academic performance. Instead of trying to make a prolific researcher of every physician, training physicians in understanding research methods and evidence-based medicine may also help improve the situation by instilling healthy skepticism and critical thinking skills.
I think I have found my true calling here. It is important to have “critical thinking skills” and understand my limitations. Instead of having fancy survival graphs for the presentations and overawing your audience with statistics, it is important to put the important points first.
The last image requires more nuanced understanding around funding agendas; I hope to cover it again in a future blog post.