Another problem is the sort of mutual push between hospitals and individual researchers. They are all liberal enemies, both in pursuit of helping people, but also in major magazines to pursue tenure and sponsorship. It is not necessarily bad – if the energy is directed. “The lowest incremental study you can do as a clinical scientist is to write down the cases happening at your center. It’s not that hard to do and it’s a low gain. But if you want to have an impact, you have to get over that, ”says Turakhia. “We must stay away from scholarly opportunism, just let you have an article, and find a way to assemble and work collaboratively.”
That opportunism is not just ambition. It actually carries the risk of disrespect (if not outright harm) to the patient. “When we do clinical research, not just one researcher says, ̵6;This is a good idea, let’s do it.’ Research is a high effort for all of us. In most cases, our patients volunteered to be a part of these studies, contributing their data and bodies to help us advance knowledge. Wang, who wrote a comment run along with JAMA Noi article. “It seems impossible, especially in the current technology and communications age, to become more efficient early on?”
Gellad is even more difficult. “Every small group is doing its own experiment instead of having a focused, organized effort to say, ‘These are the most important central efforts. These are the tests we will do, ” he said.
Blame the system, if you want to. Large treatment trials are very expensive, so only pharmaceutical companies and governments have a bank account to do. A variety of potential donors, from the NIH to the Gates Foundation, etc., pull researchers in many directions. The lack of patient-centric data means that even when the hospital system and researchers want to collaborate, they can hardly talk to each other by speaking digitally. Mechanisms that protect patients’ rights and keep them safe during research trials are fragmented and independent; No one has suggested the removal of institutional review boards in individual hospitals and research centers, but a large research process may have to handle dozens of them, each with veto power. . And finally, as reporter Susan Dominus demonstrated in a recent article in New York Times Magazine, hospital doctors and clinicians may feel that their obligation to patients means they should try anything and everything to save their lives, rather than enrolling them in studies. The study may randomly place them in the control group (although the final study could save more lives).
These issues always challenge drug trials and the people who do them. Like so many system failures, pandemic just makes the problem worse. Peter Bach, director of the Medical Results and Policy Center and the Drug Pricing Laboratory at Memorial Sloan Kettering Cancer Center, said: “Without a doubt, we lack any approach that has organization and any system to test treatment ideas. Bach says that small trials have a risk of false positives, studies that use difficult results instead of mortality, and all other weaknesses leading to erroneous and lackluster results. the general is obviously bad, ‘but I don’t know what to say than it’s always been like this, really. ”
Exposing these problems can provide motivation and ideas to fix them. Turakhia thinks a solution – possibly for the next pandemic – will be an entire network of centers ready to conduct clinical trials immediately. Just fill in the nouns in the papers. “We need a range of locations ready to operate. “We signed the contract, the IRB has a fast tracking mechanism,” he said. “You just need the right infrastructure and affordability and a commitment to vision. Operational aspects, approvals and all that – you can set and operate all of that. “
It’s the kind of system that could actually make the world a better place, if someone built it. “We all agree that it is imperative to do this, and time is of the essence,” Wang said. “Now we just need to build a machine that can run a little faster. And I’m sure this machine will survive the pandemic. Switching from a rotary wheel to a synchronous rotary gear would not be an easy lift, but it is clearly a necessity.
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