Another problem is the type of internecine push-and-pull in hospitals and individual researchers. They are all frenemies, all pursuing the goal of helping people, but have also been published in large journals in pursuit of office and provision. That is not necessarily bad – if energy gets direction. “The lowest study you can do as a clinical scientist is to write down the cases that come to your center. It is not difficult to do, and it is a low lift. But if you want the effect, you have to reach that, “said Turakhia.” We need to stay away from academic opportunity, so you have a role, and learn how to come together and work together. “
That opportunity is not just ambition. Really disrespectful (if not directly harmful) patients. “When we do clinical research, it̵7;s not just a researcher who says, ‘Here’s a great idea, let’s do it.’ Research is a high-stakes effort for all of us.Our patients volunteer, in most cases, to be part of these studies, contributing data and their bodies to help we advance knowledge. There is a cost to research, “said Wang, who wrote a comment that ran next to JAMA Internal Medicine article. “Isn’t it possible, especially in this age of communication and technology, to get better early?”
Gellad takes a harder line. “Every small group takes its own test instead of having an organized, central effort to say, ‘This is the most important central effort. These are the tests we will do,'” he said.
Blame the system, if you will. Large therapeutic tests are expensive, so pharmaceutical companies and governments tend to remove banks. A full grab bag of potential funds, from the NIH to the Gates Foundation and others, is taking researchers in many directions. A lack of central patient data means that even though hospital systems and researchers want to collaborate, it is difficult for them to communicate with each other, digitally speaking. Mechanisms for protecting the rights of patients and keeping them safe in research trials are widespread and independent; no one proposes to remove institutional evaluation institutions in individual hospitals and research centers, but a large learning protocol can deal with dozens of them, each with veto power. And finally, as reporter Susan Dominus points out in a recent article on The New York Times Magazine, hospitals and doctors may feel that their role in patients means they should try anything and everything to save their lives, rather than enrolling them in studies that can make those random it in the control group (although learning can save more lives in general).
These problems have always challenged drug tests and the people who mounted them. Like so many system failures, the pandemic only exacerbated the issue. “There is no doubt that we lack any kind of organized and systematic approach to testing therapeutic ideas,” said Peter Bach, director of the Center for Health Policy and Results and the Drug Pricing Lab at the Memorial Sloan Kettering Cancer Center. Bach said small trials that risk false positive results, studies that use squishy outcomes rather than mortality, and all other vulnerabilities that lead to biased results and lack of generalization are clearly bad, “but I don’t know what to say than it always is, really.”
Exposing these problems can provide incentives and ideas to fix them. Turakhia thinks one solution – perhaps for the next pandemic – is a whole network of centers ready to mount clinical trials on a notice. Just fill in the nouns on the paper. “We need a bunch of sites that are a priori ready to go. ‘We signed off, IRBs have a fast mechanism,'” he said. vision. Aspects of operation, approval, and all that – you get it all and you run. ”
This is the kind of system that can make the world a better place, if someone builds it. “We all agree that there is a need to do this, and time is the essence,” Wang said. “Now we just have to make the machine run faster. And I’m sure this machine will continue after the pandemic.” Switching from rotating wheels to synced gears is not an easy one. lift, but clearly it is necessary.
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