Disappointingly most clinical research is wasteful as it is either futile or risky for patients [1]. Often its questions pursue aims other than the unmet clinical needs they claim to address, and their methods cannot provide patients with useful and reliable answers. Limitations include the use of inappropriate controls or no controls at all, the abuse of placebo when effective treatments are available, the adoption of surrogate outcomes that mean little if anything to patients, and the inclusion of too few patients to see an effect that is not due to chance.