The implications and relevance of a study showing that 54% of clinical trials recently published in the three most influential general medicine journals New England Journal of Medicine, Lancet and JAMA presented modifications in important study design features after recruitment of the first trial participant [1], have been commented in this Journal by four experts [2,3]. These Commentaries were written from two different and complementary perspectives, that of clinicians/investigators [2] and that of regulators [3].
