When we think about preparing for pandemics, we think about vaccines, stockpiles of drugs, and surveillance. We rarely think about research. This oversight means that when big epidemics hit, like the swine flu pandemic of 2009, scientists lose valuable chances to find more about these illnesses. A new consortium is out to change that. I wrote about their work, and the problem of slow clinical research in a new feature for the BMJ, which I’m reprinting here.
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While viruses are fast and adaptable, clinical research is lumbering and cumbersome. Epidemics tend to arrive with little warning, spread quickly, and end abruptly. By contrast, clinical trials can take months to plan. Forms must be designed to record the right data and ethical approval must be sought. By the time would-be researchers can vault over these obstacles the epidemic is history. This explains why, during the 2009 A/H1N1 influenza pandemic, virtually no patients were enrolled in a randomised controlled trial designed to identify the best ways of treating the infection.
Such trials are the gold standard of medicine and the best way of getting rigorous evidence for a treatment’s effectiveness. During the pandemic millions of people were treated with the front line drug oseltamivir (Tamiflu). But the only evidence that oseltamivir actually saved lives came from retrospective observational studies, with all the biases they entail. To this date, serious questions remain about the drug’s effectiveness. “A Tamiflu trial during the last pandemic would have resolved all the controversy over whether it works or not,” says Mike Clarke, Director of the UK Cochrane Centre.
