This article develops arguments for the use of decision theory, rather than intuition, to determine the size of trials. It is wrong to expect doctors to ignore personal preferences in favor of clinical experiments unless the trial is capable of showing differences in treatment effect that would influence clinical practice substantially. It follows from our analysis that if delta (the treatment effect that the trial is designed to detect) is sufficient to alter clinical practice, then the alpha and beta errors of a trial should be equal. This applies even if a new treatment is to be compared with conventional therapy or if a treatment with high “costs” is compared with a less invasive or more inexpensive method.

The French health system is a complex organization that has developed since 1945 as the result of a subtle combination of two fundamental principles: liberal medicine — the freedom of both the consumers and the producers of care, and solidarity — universal access to health care — embodied in a quasi-generalized system of health insurance (4).

Today, this balance, to which the French are uncontestably dedicated, appears to be precarious. It has gradually become apparent that the financing system—80% of which is based on mandatory deductions and is intended to guarantee the balance between freedom of choice and universal access — is not consistent with the dynamic of health expenditures. The growing costs of care, as witnessed by the increase of health expenses as a percentage of total household expenses from 4.5% in 1950 to 13.3 in 1985, has led to increased state control over the health care system since 1975.

Twelve federal agencies and one cross agency program spent roughly $2.7 billion in fiscal year 1987 in support of research and development in biotechnology, according to a report by the Congressional Office of Technology Assessment (OTA) that was released today. Federal support of biotechnology has increased every year since 1984.

The National Institutes of Health contributed by far the largest share of federal support, approximately $2.3 billion, or 84%; the Department of Defense, $119 million, the National Science Foundation, $93.8 million; the U.S. Department of Agriculture, $84 million, and the Department of Energy $61.4 million, OTA reports.

The average lifetime cost of care for AIDS patients in the Kaiser Permanente Northern California (KPNCE) is $35,054, according to a study released today by the Congressional Office of Technology Assessment (OTA).

The study was prepared for OTA by KPNCR, part of the Kaiser Permanente Medical Care Program, the nation's largest prepaid group practice health plan. KPNCR provides medical and hospital services to more than 2 million people in northern California-25% of the area's population.