Often, interventions to be evaluated should be compared with other intervention(s) or usual care rather than with inactive (placebo) interventions or non-intervention. This is especially the case when there is already available care that is accepted to be effective and safe, and therefore cannot be omitted from the comparison for scientific, clinical and ethical reasons. In such cases, we speak about head-to-head comparisons in the context of comparative effectiveness research . These terms underline that, in the interest of optimizing patient care and research waste control, clinical effectiveness research must focus on comparing the best possible options, and stop only documenting interventions to be better than fake interventions without having been tested against active intervention(s) already known to be efficacious.
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