International Circulation: Absolutely. What is your opinion perhaps on the advantages and disadvantages of registry studies compared to randomized clinical trials. I am sure they both have their place. but.. Can you?
Jack Lewin: Randomized controlled trials are still the golden standard and we will remain so. But randomized controlled trial sometimes takes eight or ten years to really complete， you know in a major way. And it may cost， in US dollars， 30， 40 or 50million dollars. Ok. You know registries could produce something different that would help. First of all， registry could help us see where we need randomized controlled trials by suggesting areas. Perhaps performance is not as good as we expect. But we can be doing something called randomized cluster trials where we actually randomize hospitals in different regions of the country and randomize medical group practices or clinics in various parts of the country using the NCDR registry and then do studies in this way. That would be much cheaper and much faster. We believe this may be a way of accelerating the progress of scientific research. Even though the randomized controlled trial remains the golden standard， we can still learn faster with registries.

 

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