Cooperative Clinical Investigation

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Abstract
EXPANSION of our knowledge and understanding of the pathological physiology of human disease during the past four decades can be attributed, in large part, to the availability of precise scientific techniques for basic research. Despite major advances in the laboratory and the introduction of elegant and sophisticated technology for the recognition and diagnosis of disease, the application of sound scientific methods for the development of better treatment programs is uncommon. The introduction of new treatment programs into widespread practice has been based largely on empiricism. In the past, clinical experiments were frequently derived from "trial and error" experiences observed in small groups of patients, with little, if any, attention paid to experimental bias or statistical significance. Chalmers et al1recently pointed out that clinical studies are seldom designed in a controlled fashion. The use of uncontrolled clinical studies to test new treatment modalities has frequently led to confusion, uncertainty,

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