Ask any breast oncologist today, and they’ll tell you they prefer anthracycline-free regimens in HER2-positive breast cancer — and that anthracyclines don’t improve response rates. So how did we accept a control arm containing anthracyclines in the DESTINY-Breast11 trial, which began in October 2021? We can’t simply call this a sponsor-driven choice. It’s the physicians who persuade patients to enroll — physicians who also receive payment for every screening and treatment visit. Let’s be honest: how do you justify to your patients a control arm that doesn’t reflect your own real-world practice? I’m open to any kind of criticism; just don’t come to me with the fairytale that anthracycline-containing arms are still the “standard.” I know this sounds a bit harsh, but we’re exhausted from having to point out flaws in control arms every time new trial results are presented. We’re now seeing control arms that no longer represent today’s standards — some even belong to history (eg. ARANOTE trial). It’s a call to all of us, as physicians, to think more carefully about the trials we support — if our genuine goal is the health and well-being of every patient, including those in the control arm.