Intended for healthcare professionals


Towards sustainable clinical trials

BMJ 2007; 334 doi: (Published 29 March 2007) Cite this as: BMJ 2007;334:671
  1. Sustainable Trials Study Group
  1. Correspondence to: I Roberts, London School of Hygiene & Tropical Medicine, London WC1E 7HTcrash{at}
  • Accepted 30 January 2007

Currently, few researchers think about the carbon footprint of their trial. The Sustainable Trials Study Group reports that clinical trials are carbon intensive and suggests ways to make them more efficient

Greenhouse gases are changing the global climate, with serious implications for health and ecosystems.1 2 All sectors of the economy, including the health sector, must act to reduce greenhouse gas emissions.3 High income countries need to cut emissions by about 90% by 2030 to limit the global average increase in temperature to 2°C, and thus reduce the risk of the most serious consequences.4

The Sustainable Trials Study Group was convened by the London School of Hygiene & Tropical Medicine to find ways of reducing greenhouse gas emissions from clinical trials. This international health research institution has an extensive research programme on the links between environment and health. A sustainability group was established to reduce the institution's carbon footprint, and this study is a product of its work.

Summary points

  • Clinical trials contribute substantially to greenhouse gas emissions

  • The main sources are energy use in research premises and air travel

  • Renewable energy sources and more efficient energy use would reduce emissions from premises

  • Simplified trial designs, reduced bureaucracy, and videoconferencing would reduce air travel

The CRASH trial case study

We conducted a carbon audit of the Medical Research Council (MRC) CRASH trial ( with the Edinburgh Centre for Carbon Management ( The CRASH trial is a multicentre international trial of the effect of corticosteroids on death and disability in 10 008 adults with head injury.5 The trial was coordinated from the London School of Hygiene & Tropical Medicine, and patients were recruited in 49 countries over five years (1999-2004). The drug was made by Pfizer in the United States and the placebo was made in France. Drug and placebo were packed in Wales. Treatment …

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