The most obvious and laudable reason for doing clinical research is, of course, to benefit the patients. Other motives that are sometimes important are to earn money, to increase chances of getting the next post, to become famous, or to satisfy curiosity. Such incentives are not necessarily bad. Indeed, the high level of competition in healthcare research may very well be more innovative and productive—and therefore more beneficial to the patients—than more centralised research approaches.

A particular piece of research may occasionally fulfil all five motives, but it would be the exception rather than the rule if research agendas overall matched even remotely what the patients need most. For example, according to the WHO, the combined investment in research and development into acute respiratory infections, diarrhoeal diseases, and tuberculosis—which kill over seven million people a year—amounts to 0.2% of global spending on health research and development, though these three diseases account for almost one fifth of the global disease burden.1

Most new interventions, by far, are developed by industry and it is no wonder that industry chooses to go where the market is. For common diseases in the developed world this leads to the development of an array of drugs belonging to the same therapeutic class. Clinical testing of all those drugs consumes a considerable amount of financial and human resources, and clinicians sometimes complain that their colleagues have “occupied” the patients by trivial trials of “me too drugs” for years to come, making it impossible to start trials of greater relevance to the patients.

Is osteoarthritis an exception to this general state of affairs? In this issue of the Annals, Chard and colleagues review 50 years of research on interventions for osteoarthritis of the knee.2 They report that most of the research was on drugs (59%) …