Kovid-19 Drug Research is a big mess


Another problem has been the intercrain push-and-pull between hospitals and individual researchers. They are all hysterical, all chasing the goal of helping people, but also getting published in big magazines in search of tenure and grants. It is not necessarily bad – if the energy is directed. “The lowest-lift study you can do as a medical scientist is to write cases coming through your center. This is not difficult to do, and it is low lift. But if you want the effect, you can overcome it. “We have to get away from academic opportunism, just because you have a paper, and find out how to mix and work together.”

This opportunism is not just ambition. This actually puts abusive (if not outright harmful) patients at risk. “When we do clinical research, it’s not just a researcher saying, ‘Here’s a good idea, let’s do it.” Research is a high level effort for all of us. Our patients are volunteers who, in most cases, contribute data and their bodies to help us gain advance knowledge, to be part of these studies. There is a cost to research, ”says Wang, who wrote a commentary that ran concurrently JAMA Internal Medicine Article. “Wouldn’t it be possible, especially in this era of communication and technology, to quickly become more efficient?”

Gellad takes an even tougher line. “Every small group was doing their own testing rather than calling it an organized, central effort,” these are the most important central efforts. These are the trials we are going to do.

If you want, blame the system. Large medical tests are expensive, so only pharmaceutical companies and governments have bank accounts to pull them. A complete grab bag of potential funders, from the NIH to the Gates Foundation and on and on, draws researchers in many directions. The lack of central patient data means that even when hospital systems and researchers want to collaborate, it is difficult for them to talk to each other, digitally. The mechanisms to protect patients’ rights and protect them during research trials are scattered and independent; No one is suggesting eliminating institutional review boards in individual hospitals and research centers, but a larger study protocol may have to deal with veto power with dozens of them. And finally, as reporter Susan Dominus showed in a recent article The New York Times Magazine, Hospitals and physicians may feel that their duty to patients means that they should try to do anything and everything to save their lives, rather than enroll them in studies that allow them to control groups Can randomize (even if the study may ultimately save overall life).

These problems have always challenged drug tests and the people who mount them. With so many systems failing, the epidemic has made the issue worse. “There is no doubt that we lack any organized and systematic approach to the testing of medical ideas,” said Peter Sloan, director of the Center for Health Policy and Outlays and a drug pricing lab at Memorial Sloan Kettering Cancer Center . Bach says that small tests that put false positive results at risk, studies that use squishy results rather than mortality, and all other weaknesses that lead to biased results and lack of generality are clearly worse. Are, “but I don’t know what to say. It’s always been that way.

Uncovering these problems can provide incentives and ideas to fix them. Turkhiya thinks one remedy – perhaps for the next epidemic – will be a complete network of centers ready to mount clinical trials at a moment’s notice. Just fill the noun on the paperwork. “We need a set of sites that are a priority to get ready to go. “We say, IRBs are a fast-track mechanism,” he says. “You just need to buy and commit to the right infrastructure and vision.” Operational aspects, approvals and all that you can get.

It is a system that can actually make the world better, if one builds it. “We all agree that there is an inevitability to do so, and time is of the essence,” Wang says. “Now all we need to do is build a machine that makes it a bit faster. And I am sure this machine will remain after the epidemic. “Moving spinning gear into the sink will not be an easy lift, but it is clearly a must.


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