Medical research stalled as NHS focuses on small number of trials, experts say

Government efforts to focus NHS resources on fewer well-designed clinical trials could inadvertently contribute to a backlog of stalled medical research and lead to the abandonment of some important trials, researchers say.

Their warning comes as a report describes the scale of ‘research waste’ that has occurred during the pandemic, with rampant duplication of scientific efforts and poorly designed clinical trials exposing millions of patients to unscheduled treatments. proven, with little scientific benefit.

Around £1billion of Department of Health and Social Care (DHSC) money is spent each year to fund medical research through the National Institute for Health and Care Research (NIHR ), which also supports those conducting clinical trials by providing additional staff, such as nurses, facilities and equipment.

When Covid hit, these staff and resources were largely diverted to researching vaccines or treatments, while scientists working in other fields put existing trials on hold or struggled to recruit patients due to coronavirus restrictions. Covid or people’s fears of catching coronavirus.

Now that some of these trials are resuming, the The DHSC asked NHS hospitals and universities conduct a review of the clinical trials they sponsor and weed out those that seem unlikely to deliver, for example studies that struggle to recruit enough patients or are not practical in due to staff availability.

“To ensure that the NHS research system continues to recover from the pandemic, we have asked sponsors and funders to carry out a review of their research – focusing on the most viable studies, which will give as many as possible the chance to succeed,” the DHSC said.

But some have warned that the DHSC review risks creating further delays and could cause some important studies to drop.

Nikola Sprigg, professor of stroke medicine at the University of Nottingham, said: “It’s a good idea in principle, but the process takes so long it leaves people in limbo and causes delays. additional.”

She fears that some studies that failed to recruit enough participants could be deemed unsustainable by the review and have their funding withdrawn, when they might have been more successful had they not been delayed.

“Often some of the most important trials are the hardest to do,” Sprigg added. “I think there needs to be some sort of process to make sure really important questions or potentially beneficial treatments aren’t dismissed inappropriately.”

Dr Simon Kolstoe, a bioethicist from the University of Portsmouth who studies research waste, said: ‘It’s a pragmatic decision, but it will be sad for many areas of research, such as cancer research, where it looks like a lot of studies. are going to have their funding withdrawn, perhaps rightly so, because they’ve been off for so long they’ll never be able to gather all the data they need to produce meaningful results.

“The concern is that if they’re not nuanced enough in how they do it, they can force studies to close, which actually, if given a bit more time, would be nice.”

However, Till Bruckner, the founder of TranspariMED, which campaigns for greater transparency in medical research, described it as a bold step that “will greatly benefit patients and taxpayers”, citing the pandemic as an example of the waste of medical research.

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According to a report released by TranspariMED and Health Action International last week, most clinical trials of potential Covid drugs have focused on only a handful of treatment options, while inconsistencies in their design have made pooling data difficult. similar studies to calculate an overall effect. As of October 2020, almost a third of the 516 trials registered in the first hundred days of the pandemic had failed to recruit a single patient, another study found.

The United Kingdom recovery test – the world’s largest randomized controlled trial of drugs against Covid-19 – was a rare example of a study that provided useful information thanks to its flexible design, which allowed it to evolve as knowledge about the pandemic were increasing.

Bruckner said: ‘The UK’s excellent Covid research program has clearly demonstrated the benefits of focusing NHS resources on a limited number of well-designed, well-funded studies that quickly show which treatments work and which don’t. . In contrast, the chaos of uncoordinated research in most other countries has yielded virtually no useful evidence.

The DHSC said every study should have a procedure to ensure the well-being of participants if they were to end early, as this is required as part of their authorization by the Health Research Authority.

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