, Volume 53, Issue 7, pp 541-543
Date: 16 Feb 2011

When research is reconciled with care and ethics with science, reimbursement for clinical procedures can be linked to trial participation

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Dear Sir,

In a recent editorial letter [1], Professor Houdart provides us with a frank but realistic evaluation of the difficulties involved in completing trials that attempt to support the value of commonly performed interventions that have yet to be proven beneficial to patients. He should be praised for putting clearly on paper what many people believe secretly but rarely admit in public.

There are indeed major practical obstacles to the success of studies like TEAM or ARUBA, intending to study the benefit of preventive treatment of unruptured intracranial aneurysms and arteriovenous malformations versus their natural history. There are two approaches to solving this problem: one, a carrot and the other, a stick. Although there may be a place for Professor Houdart's coercive approach, we would like to consider the various possible incentives (or carrots) we should try first. Perhaps we can change first the way we evaluate the expertise, credentials, or reputation of centers, by taking