Randomized clinical trials have become crucial to getting the most out of proven medicines and honing the effectiveness of different types of treatments, says Dr. Paul Hébert.
As vice-chair of the University’s Department of Medicine and holder of the chair in Transfusion and Critical Care Research at the Ottawa Health Research Institute (OHRI), Dr. Hébert has studied how the work of researchers finds its way into widespread use. He was among three representatives of Ottawa’s health care community who shed light on the clinical trial process as part of a panel discussion on the topic during the 12th BioNorth conference, an annual event mounted by the Ottawa Life Sciences Council.
Clinical trials represent the best means of determining both the efficacy of new therapies, and the best way of applying them, according to Dr. Hébert.
He offered a number of examples, including studies focussing on aspirin to prevent heart problems in stroke victims, the blood hormone erythropoietin to deal with complications associated with kidney failure, and the corticosteroid prednisone to help patients suffering from obstructive lung ailments. Such studies can change the way doctors treat their patients as unbiased trials reveal “best practices.”
“We’re now looking for smaller and smaller increments in health benefits amongst our patients,” says Dr. Hébert.
In that light, a concept known as “equipoise” takes on special significance. This term refers to any uncertainty within the medical community about the best type of treatment, which justifies carrying out a trial to discover the answer.
According to panellist Dean Fergusson, an epidemiologist with the OHRI, equipoise broaches the ethical difficulty of administering an inferior or ineffective therapy to some patients participating in such a trial.
While some trials are sometimes stopped in mid-course when the value of a drug has been overwhelmingly proven, Dr. Fergusson noted that others may proceed because researchers are unaware of earlier studies in which the effectiveness of a therapy has already been shown.
Dr. Fergusson called for systematic reviews “to prevent unnecessary and unethical trials from being conducted, reduce the number of redundant trials, and reduce the number of patients randomized to inferior treatment.”
A third speaker, Katie Lafferty, executive director of the Canadian Stroke Network, pointed to research carried out by this Ottawa-based organization that has identified new standards for minimizing the effects of a stroke, as well as helping individuals recover from those effects.
“We really feel that Canada is poised to set an example for the world,” she says, describing the national and provincial strategies that have emerged from the network’s various initiatives. Despite the logistical difficulties of implementing recommended procedures in day-to-day practice, the public and professional awareness of those procedures continues to grow.
