Gordon McVie campaigned throughout his career for merging scientific and clinical expertise and for investigating the underlying pharmacokinetics and pharmacodynamics in clinical trials. This need remains highly relevant today when most cancer clinical trials investigate agents that target a known molecular pathway, yet anticancer drug development has changed minimally from that used for chemotherapy when more was better and substantial toxicity inevitable. Here, I summarise some common problems that confound current drug development, including problems in interpreting results of phase 3 randomised trials, as well as trials investigating personalised medicine.