Abstract

Neurological disability may be prevented, or it may be alleviated if prevention is impossible or ineffective. Research into prevention and alleviation can be "laboratory" or "clinical", the latter being no less scientific than the former. All proposed treatments must be properly evaluated to ensure that effective interventions are widely adopted and ineffective ones abandoned. Unless an intervention has a major effect on outcome (which most do not), the most efficient assessment is by random allocation of patients to the new intervention versus the old. Although there were, and still are, forces opposed to the proper evaluation of treatment, there are strong economic clinical arguments in its favour, which will lead to appropriate targeting of scarce health resources.