[50 years of clinical trials; a new direction in medicine]

In 1998 the medical community commemorated the completion of the first truly randomised trial, the Medical Research Council Streptomycin Study. This invention is at least as important as Harrison's clocks, which in the 18th century solved the problem of measuring longitude at sea. Naturally the idea of randomised controls had evolved from previous notions. Obtaining informed consent remains essentially a matter between patient and physician, but in the meantime four other interested parties have joined in: governing bodies, the pharmaceutical industry, medical journals, and the mass media. In order to keep all these forces in check, lawmakers should protect the weakest parties against the more powerful ones. There is a great deal to be done in the next 50 years.