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In Reply: In response to Drs Boutron and Ravaud, we suggested that this change in practice was probably due to premature and unjustified declines in clinicians' and patients' uncertainty about the efficacy of an experimental treatment. We suggested that this change in assessment was not based on scientific evidence but, rather, reflected that the treatment was being tested in a randomized controlled trial.

We also suggested that when a trial is not blinded, clinicians' impressions (right or wrong) of an emerging favorable trend might further increase their use of the experimental treatment. Boutron and Ravaud have suggested the additional term "jumping ahead" for this phenomenon. Although we remain unconvinced that our observations support their proposal, we look forward to future studies to determine how often jumping the gun occurs in concert with randomized trials in other fields.

William F. Clark, MD, FRCPC; Amit X. Garg, MD, FRCPC; Peter G. Blake, MB, FRCPC
Division of Nephrology
University of Western Ontario
London

David L. Sackett, MD, FRCPC
Trout Research and Education Centre of Irish Lake
Markdale, Ontario

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;290:3072.

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Premature Application of Trial Results to Clinical Practice
Isabelle Boutron and Philippe Ravaud
JAMA. 2003;290(23):3072.
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