Table 1

Why distinctions between research and clinical care no longer hold up

Distinguishing characteristicWhy it does not hold up
Research is designed to develop generalisable knowledgeClinical care is a continuous source of data for the production of generalisable knowledge, and that knowledge in turn continuously changes and improves practice.
Research requires a systematic investigationSystematic data collection is common in clinical care, is viewed as good practice and is sometimes obligatory.
Research presents less clinical benefit and greater overall riskEvidence suggests that clinical care can harm patients and lead to suboptimal outcomes due to inadequate evidence, unproven traditional practices and biases in clinical judgement, sometimes due to medical errors and lack of supervision in clinical care.
Research introduces clinically irrelevant burdens and risksSeveral studies show that using clinical services exposes patients to burdens (eg, poorly coordinated tests requiring numerous hospital visits) and risks (eg, to privacy and confidentiality) without conferring clinical benefit.
In research, protocols dictate which interventions a patient receives (thus the offered activity is less individualised)In clinical care, external constraints limit care, such as geographical location, hospital catchment area, which clinician they see, which medicines are available. Moreover, some research studies (eg, clinical trials of medicines) can accommodate researchers’ and participants’ preferences.