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Adaptive trials are now mainstream science. Recently, researchers have takenthe adaptive trial concept to its natural conclusion, proposing what we call"Global Cumulative Treatment Analysis" (GCTA). Similar to the adaptive trial,decision making and data collection and analysis in the GCTA are continuous andintegrated, and treatments are ranked in accord with the statistics of thisinformation, combined with what offers the most information gain. Where GCTAdiffers from an adaptive trial, or, for that matter, from any trial design, isthat all patients are implicitly participants in the GCTA process, regardlessof whether they are formally enrolled in a trial. This paper discusses some ofthe theoretical and practical issues that arise in the design of a GCTA, alongwith some preliminary thoughts on how they might be approached.

Theoretical Issues for Global Cumulative Treatment Analysis (GCTA)