Unless you actually start looking into the whole of the aids epidemic its easy to miss what an absolute clusterfuck it was. The systems in place weren’t prepared at all for it and through a combination of maliciousness, ideological hardheadedness, and novel circumstances more Americans were killed by a virus than by the Viet Cong. But because it hit a group that was already fighting for our rights as well as the fact physicians in high places understood that their duty was not to the public “morality” but to public health things were able to be fought.
Comment on The FDA Is Approving Drugs Without Evidence They Work
Neuromancer49@midwest.social 3 weeks ago
The article brings up some great points, some of which that I, an industry insider, weren’t even aware of, especially the historical context surrounding the AIDS epidemic. I’ll jump into the thread to critique an issue within the article.
One of the four pillars recommended by the FDA (control groups) are great in theory but can lead to very real problems in practice, specifically within indications that have an unmet treatment need or are exceptionally rare conditions.
If you have a disease that is 99% fatal but has 0 standard of care treatment options, is it ethical to ask a participant to enroll in a clinical trial and potentially not receive the study treatment/be on placebo? Or, what if the trial involves an incredibly invasive procedure like brain surgery - is it ethical for people to do a placebo procedure? Food for thought - and an explanation for why so few trials meet all four criteria proposed by the FDA.
Happy to answer questions about the industry if anyone has them.
captainlezbian@lemmy.world 3 weeks ago
Bluewing@discuss.online 3 weeks ago
Medicine has always relied on killing enough patients to determine how safe/effective or not a drug or procedure might be. We simply do not have the technology to provide definitive answers any other way as of yet. This is why one “practices” medicine and not “does” medicine. And administering a drug to a patient is called a “trial.” There is simply no way to know the outcome until the outcome arrives. Years of experience can give you a fair indication of what to expect, but expectations are not definitive answers.
As a keynote speaker ER Doctor stated at an EMS seminar I attended, “No matter how much knowledge and skills we think we know and have, modern medicine still boils down to doing things to keep the patient amused and letting nature take it’s course.” As a simple medic, that was a thought that stuck with me through my 15 years in the back of the bus. It scared the bejeezus out of me.
altphoto@lemmy.today 3 weeks ago
Opening someone’s head to pretend to have done something sounds very unnecessarily cruel and stupid.
webghost0101@sopuli.xyz 3 weeks ago
Thats their point. How do you test placebo effect for a surgical operation?
ToastedRavioli@midwest.social 3 weeks ago
Either way, that is a pretty massive digression from the article, which is about medications. Apparently more people are dying on average from recently approved drugs than are dying from all illegal drug use combined
Neuromancer49@midwest.social 3 weeks ago
Fair point, but a lot of the article talks about how many studies aren’t meeting all four pillars of clinical trial design - that’s where my issue comes in, I think reporting that X% of trials do not meet all pillars is a bad metric.
And, not all medications these days are pills or IV infusions - some medications and treatments, which are governed by the FDA, are more invasive and more complicated.
bss03@infosec.pub 3 weeks ago
You can do single-blind. You do prep, anesthetize, then open the card that decides if the surgery continues, or if the patient is simply awakened at the expected time.
You can also do it for surgeries that use locals, but then the surgical staff has to do a lot of miming/acting instead of actual cutting.
Medlife Crisis did a could of Placebo effect videos, and mentioned that he participated in a single-blind stent study.
I don’t know how you’d do double-blind.
webghost0101@sopuli.xyz 3 weeks ago
That a great take.
Double blind could be a different team comes In and either does the surgery or fakes it. And this team also does or Fakes the after care.
This team is never to communicate with patient or normal staff.
Vorticity@lemmy.world 3 weeks ago
Thank you for providing the extra context. That’s very helpful.
ClockworkOtter@lemmy.world 3 weeks ago
When it comes to therapies that are likely toxic, e.g. chemo, that’s why the sponsor has to demonstrate through pre-clinical data that there is a high enough likelihood that the benefits will outweigh the harm that it is a legitimate therapy to trial on humans. Even then there should still be thorough, audited processes for obtaining fully informed consent before recruiting patients into these trials, including making certain they are aware the trial may cause more harm than standard of care.
It’s the burden of evidence required in pre-clinical data that makes me defend animal testing despite being vegan.
Neuromancer49@midwest.social 3 weeks ago
The consent process for clinical trials has a ton of guidance (ICH GCP), but the onus is on the clinical monitors and hospitals to make sure it’s done correctly. Many trials now generate supporting documentation in which hospital staff are required to describe the circumstances in which consent was acquired. If the documents are generated, then it’s auditable.
Things get a bit hairy when you look at trials in Alzheimer’s and other cognitive disorders, because the patient may not be coherent enough to withdraw from the trial. In those cases, a legal guardian is responsible for the decision.
ClockworkOtter@lemmy.world 3 weeks ago
Yes, though if the sponsor is doing it on the cheap then they might pick facilities and monitors who don’t care or don’t have the capacity to pick up on all the details, or scrutinise minutiae. The monitor can only QC what’s written down for example, and an investigator can be perfectly capable of having the bare minimum of a consent process and copy pasta as if it was done thoroughly.
I’m glad all my participants are of sound mind; the idea of navigating the world of incapacity and research gives me the heebie jeebies.
Neuromancer49@midwest.social 3 weeks ago
Good point, I’m assuming all monitors are as good as mine.