The search for optimality in clinical trials

Summary Much technical work has been devoted to the construction of schemes for optimizing some measure of the outcome of a clinical trial. The main ideas have been the use of data-dependent allocation, by which a majority of patients will tend to be assigned to the better treatment, and a decision-theoretic approach to the optimal allocation of treatment for a large 'horizon', including patients treated after the end of the trial. These ideas have rarely been used in practice, and some of the reasons for their neglect are outlined. It is suggested that more collaboration is needed between the proponents of these models and those statisticians concerned directly with the design and analysis of trials.

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