New Scientist article on drug trials 23/10/2124 Oct 2021 13:07
The article is too long to post fully so here's a brief 2-part summary:
Part 1 - Problems with current approaches to drug trials
Between 2015 and 2016, the median cost of a clinical trial was $19 million.
Then there is the time it takes to chaperone a drug from invention through trials to approval, which is often upwards of 10 years. Trials can also be costly to the volunteers themselves. There is often a 50:50 chance that someone involved in a trial will get only a placebo. Perhaps that explains why participation is woefully low – a 2017 study found that only 4 per cent of people diagnosed with cancer choose to take part in an Randomised Controlled Trial.
The first big problem with conventional trials is that they build the same research infrastructure for each drug tested. Everything from the recruitment of admin staff to bed space and the statistical models are organised from scratch for each trial. That is like building a new stadium for every football game.
Clinicians now sometimes use what is called a platform trial. Here, scientists create an infrastructure that can be used again and again. What’s more, researchers can share a single control group across multiple trials of different drugs, as well as test therapies head-to-head against each other. This kind of trial doesn’t ask “is one particular drug effective?”, but “which drug is the best at treating a certain condition?”.
A second shortcoming of RCTs is that lots of participants are given a placebo. An approach that takes the edge off this is called an adaptive trial. In these trials, what each person gets is determined by rules that are written before the trial. For example, if lots of patients have benefited from a particular drug, then the odds that a patient coming later in the trial will also be given that drug are increased. In practice, the allocation of treatment to a patient is determined by a computer algorithm, so the doctors running the trial remain blinded to who gets what.
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