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It may appear that the clinical research enterprise is functioning well, even thriving. Nearly 30 000 trials globally are recruiting patients, and results from 75 trials are published daily in biomedical journals. However, there is a crisis, with an attendant opportunity, that requires change. A wall surrounds much of these clinical research data, sequestering knowledge, impeding the free flow of information, and obscuring a clear view of the totality of evidence relevant to many research questions and clinical decisions.

Nearly half of clinical research trials are never published. Moreover, publications are often incomplete, selectively reporting favorable outcomes and infrequently reporting relevant safety findings. Motivations and explanations for this phenomenon vary, but whether intended or not, selective publication distorts the medical evidence and inhibits the flow of information that is vital to decision making by patients and their clinicians.

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