Descriptive survey of non-commercial randomised controlled trials in the United Kingdom, 1980-2002
BMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7422.1017 (Published 30 October 2003) Cite this as: BMJ 2003;327:1017
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Iain Chalmers and colleagues (1) highlight from their
survey of non-commercial randomised trials the
challenges faced by researchers seeking funding for
trials addressing issues not of interest to industry. For
any large multicentre clinical trial to reach its target
accrual, it is essential that the clinical research
community is committed to the trial at the very earliest
stages of its development.The current financing of peer
reviewed trials by the Department of Health and the
Medical Research Council only begins once a full
proposal is approved.However costs are incurred in the
process of developing a full proposal. In particular
these are generated by national meetings to discuss
and develop the detailed protocol and the
administrative support for revisions of the text.
While
much of the communication between clinicians can be
done by email, meetings of clinicians face to face are
needed to debate the research question and
practicalities for a clinical trial. In a trial supported by
industry, these meeting expenses are normally
reimbursed. This is not the case for non commercial
trials where study leave budgets for cancer
professionals are often inadequate and discourage
wide participation.
What is needed is a more level
playing field.A way forward may be the creation of NHS
Research and Development/MRC budgets (perhaps
£1000-£2000) for meeting and travel expenses for
shortlisted proposals to facilitate the development of
full proposals. This might encourage and accelerate
the conduct of non commercial trials of
interest to clinicians and patients.
References:
Chalmers I, Rounding C, Lock K.Descriptive survey of
non-commercial randomised trials in the United
Kingdom 1980-2002. BMJ 2003; 327:1017-9.
Competing interests:
IHK has received
research funding from
the Department of
Health (Research and
Development)
Competing interests: No competing interests
Dear Sir,
It was very depressing to read the paper of Chalmers et al(BMJ
2003)(1), Descriptive survey of non-commercial randomised controlled trials
in the United Kingdom, 1980-2002. My comment:
1.There was steady increase in the number of research till 1996, after that
there was a steady and sharp decline in the number of those sorts of
research work which are supported by main non-commercial sources.
2.We ought to look into other countries to see whether there was a similar
trend,like other European countries,United States ..etc.
3.With such a decline in the number of those sorts of research work which
are supported by non-commercial sources, it means we ought to depend more
on drug companies for funding!
4.What is the solution? Drug companies & private sector can
participate in the funding of research work through contributions to the
NHS, Medical Research Council & Charities.
Thanking you,
Yours sincerely,
A.K.Al-Sheikhli,MRCPsych,DPM.
References,
1.Chalmers I,Rounding C & Lock K,Descriptive survey of non-commercial
randomised controlled trials in the united Kingdom , 1980-2002,BMJ
2003,;327:1017.
Competing interests:
None declared
Competing interests: No competing interests
Ideally there should be a tax on pharmaceutical profits, other health
related industry, and a charge on every hour a NHS bed or patient is used
for trials and consultant's time. The money should be pooled in a trust
fund which the public can contribute to if it wishes, as with other
charities. This fund does not need to incorporate charitable funds with
special interest, such as cancer research, but it could be managed by
intelligent people independent of the health industry.
Then students and independent researchers will be able to apply for
funding for what 'they' want to study, not what they are told or advised
to research by commercial interests.
Why should companies be allowed to use patients freely and then have
the audacity to make medication and health care beyond the pocket of the
people it's intended for! Commercial companies also need to take some
responsibility for the essential mundane research which props up the
health industry which they thrive on.
Cures for diseases have to be found and these come from the hearts
and minds of researchers with a passion, tenacity and the funding to see
them through. We have a system which is actively discouraging cures for
disease in favour of lengthy therapies and over vaccination. Great
research in history hasn't had to be politically or commercially
influenced, why should it be today?
Competing interests:
None declared
Competing interests: No competing interests
Meeting the need of the NHS for evidence from randomised clinical trials
Meeting the need of the NHS for evidence from randomised clinical
trials
Dear Sir
The public in general and NHS patients in particular ought to benefit
from advances in knowledge about prevention, treatment, rehabilitation and
care. There has been important progress in disseminating relevant
information through the National Electronic Library for Health and through
the work of the National Institute for Clinical Excellence (NICE), but
more investment in randomised clinical trials is vitally needed to test
the validity of hypotheses and findings derived from basic research.
The Medical Research Council (MRC) remains the largest public funder
of clinical trials and has steadily increased its investment in randomised
clinical trials (see attached figure), even during the recent period of
severe financial constraints for responsive mode funding. But there has
been a worrying decline in the total numbers of non-commercial randomised
trials in the UK, including those supported by the NHS Research and
Development Programme (1). Considering the needs of the NHS, the overall
public support for randomised clinical trials remains modest compared with
that for other areas of biomedical science. Substantial investment is
needed in infrastructure, personnel and other resources if the number of
trials is to keep up with the need.
Reports published last month by the Academy of Medical Sciences (2)
and the Bioscience and Innovation Growth Team, for the Department of Trade
and Industry (3), recommended initiatives to ensure that research to
assess the effects of new treatments in practice is conducted as
efficiently as possible after discovery in the laboratory.
We welcome the government’s announcement that key stakeholders will
develop practical proposals for improving patient benefits from clinical
research in a working group led by Sir John Pattison, the Department of
Health’s Director of Research and Development. It is time to translate
into practice the theory that the UK’s National Health Service provides a
uniquely valuable resource for efficient assessment of the effects of
healthcare interventions of potential benefit to its patients.
The MRC has recently set out its future strategy for supporting
clinical trials (4) and intends to make clinical research a high priority
in its proposals for the Spending Review 2004. It stands ready to play a
central role in a strengthened commitment to clinical trials.
Yours faithfully
Colin Blakemore, Chief Executive, Medical Research Council
Iain Chalmers, James Lind Initiative
References
1. Chalmers I, Rounding C, Lock K. Descriptive survey of non-
commercial randomized trials in the United Kingdom, 1980-2002. BMJ
2003;327:1017-9
[http://bmj.bmjjournals.com/cgi/content/full/327/7422/1017].
2. Academy of Medical Sciences. Strengthening clinical research. October
2003. [http://www.acmedsci.ac.uk/p_scr.pdf].
3. Bioscience Innovation and Growth Team. Increasing national health,
increasing national wealth. November 2003
[http://www.bioindustry.org/bigtreport/].
4. Medical Research Council. Clinical trials for tomorrow. July 2003
[http://www.mrc.ac.uk/index/current-research/current-
clinical_research/current-clinical_trials/current-
clinical_trials_for_tomorrow.htm
Competing interests:
None declared
Competing interests: No competing interests