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(I would not let L go that easily after a - to me - lighthearted comment.)

"Are you implying all mega-trials are useless ?" I pursued on the topic.

"No, but quite so I must say," my friend smiled, "If a new treatment is cheap and harmless, it really doesn't matter if it helps only marginally for an uncommon condition. The problem is, hardly any new treatment falls into that category."

I was forced to agree, "Quite so, except perhaps some public health measures that, say, you find in The Lancet. But I would argue human life and suffering are priceless - and medical researchers should do everything and test every possible measures to treat our patients."

"No, there is a price for everything - including human life and suffering," L murmured in a voice that I could hardly hear. After a moment of silence, he continued, "Even if we do away with the monetary cost, there are good reasons against mega-trials."

"Yes ...?"

"First, it involves exposing a large number of subjects to a new medicine with relatively unknown risk. After all, if we are so concerned about rare adverse events that we have to recall propoxyphene, how could we ever be sure the drug under testing is safer than the good old Dologesics ?"

"True, but that remains a balance of probability, or between risk and benefit," I retorted.

"Quite right. But my major concern is the opportunistic cause and damage to the fourth party."

"What !?"