A number of solutions are sought, including the optimization of protocols, measures to ensure the enrollment of validly acute patients, concealing the duration of the placebo run-in phase from the investigators to reduce “baseline rating inflation” (i.e., rating patients more severely ill than they actually are so that they meet the inclusion criteria), the development of more sensitive rating scales and better rater training, and the use of remote independent raters through telephone or video examinations (for a review, see reference 3). In our opinion, recruiting truly acute patients is the key issue, but current trials are so complex that in fact such patients are rarely enrolled. Many antipsychotics are available, so patients think twice before they participate in a trial, leaving the field to partially refractory patients hoping for a more efficacious drug. Consent forms are very long, and eligibility must be carefully screened, so that at the end of the process only stabilized (although still symptomatic) patients are recruited after short washout phases, turning acute-phase studies to some degree into withdrawal studies. Many participants are “professional patients” recruited by newspaper advertisements who benefit from small financial incentives.