Display Settings:

Format

Send to:

Choose Destination
See comment in PubMed Commons below
Milbank Q. 2008 Dec;86(4):533-55. doi: 10.1111/j.1468-0009.2008.00533.x.

What ever happened to N-of-1 trials? Insiders' perspectives and a look to the future.

Author information

  • 1University of California, Davis, USA. rlkravitz@ucdavis.edu

Abstract

CONTEXT:

When feasible, randomized, blinded single-patient (n-of-1) trials are uniquely capable of establishing the best treatment in an individual patient. Despite early enthusiasm, by the turn of the twenty-first century, few academic centers were conducting n-of-1 trials on a regular basis.

METHODS:

The authors reviewed the literature and conducted in-depth telephone interviews with leaders in the n-of-1 trial movement.

FINDINGS:

N-of-1 trials can improve care by increasing therapeutic precision. However, they have not been widely adopted, in part because physicians do not sufficiently value the reduction in uncertainty they yield weighed against the inconvenience they impose. Limited evidence suggests that patients may be receptive to n-of-1 trials once they understand the benefits.

CONCLUSIONS:

N-of-1 trials offer a unique opportunity to individualize clinical care and enrich clinical research. While ongoing changes in drug discovery, manufacture, and marketing may ultimately spur pharmaceutical makers and health care payers to support n-of-1 trials, at present the most promising resuscitation strategy is stripping n-of-1 trials to their essentials and marketing them directly to patients. In order to optimize statistical inference from these trials, empirical Bayes methods can be used to combine individual patient data with aggregate data from comparable patients.

PMID:
19120979
[PubMed - indexed for MEDLINE]
PMCID:
PMC2690377
Free PMC Article

Images from this publication.See all images (1)Free text

Figure 1
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Icon for Blackwell Publishing Icon for PubMed Central
    Loading ...
    Write to the Help Desk