Because of concerns about the real-world applicability of clinical trials and about improving the quality and value of health care, “pragmatic” trials are attracting increasing attention. These trials have both important strengths and inherent limitations.

Shortly after the FDA approved the costly sipuleucel-T (Provenge) for treating prostate cancer, the Centers for Medicare and Medicaid Services opened a national coverage analysis for the drug, risking duplication of effort and impeded patient access.

The recent approval by the Food and Drug Administration of Makena, a new version of progesterone 17 alpha-hydroxyprogesterone caproate, will drive up the drug's cost about 100-fold, with minimal added clinical benefit.

How little must patients and their relatives really understand of our attempts to communicate with them. How many cues are missed on an average ward round? Could the way we talk make relatives feel uncomfortable instead of involved?

Nearly half the pregnancies that occur each year in the United States are unintended, according to the Guttmacher Institute. In 2001, an estimated 3.1 million pregnancies were reportedly unwanted or mistimed, and by 45 years of age, nearly half of U.S. ...