“…Advances in trial methodology, such as the development of cluster-randomized trials, enable the testing of interventions best randomized at a group level (Eldridge et al, 2008;Hemming et al, 2017) whereas the emergence of adaptive trials makes efficient use of scarce resources, be they time, enough patients to go into the trial or cost of the trial (Bhatt and Mehta, 2016). Within regulatory authorities and pharmaceutical companies there is interest in more rigorous ways of making decisions about the licensing of medicines, drawing on well-understood, but less well-used, statistical principles, in combination with other skill sets (Hughes et al, 2016).…”