Targeted junkmail "from" your GP?

[Ian Batten]

>
>
> I look forward to seeing the funding arrangements that ensures that
> trials become so extensive that everyone can take part...

Put bluntly, you enrol people on small-scale RCTs for terminal  
cancers, say, precisely because they've got terminal prognoses.  If  
they're assigned to the placebo arm of the study, no change, and the  
die.  Assigned to the active arm of the study, either it's neutral and  
they die when they would have done, or it's harmful and they die a  
little earlier (and they knew the score), or it's beneficial and they  
die a little later.  Over sufficient people to make the study  
worthwhile perhaps you, net, add or subtract a few tens person-months  
of life, do the analysis and move on to the next stage.

It would be quite another thing is everyone vaguely possible for the  
study were enrolled.  Then it's not a few tens of patients under the  
care of one consultant's firm, who understand the trial and the  
potential outcomes.  Now it's people hundreds of miles away, with  
standard hospital care, taking experimental regimes.  Now if it turns  
out to be bad when the numbers are totted up at the end of a trial,  
it's thousands of person-months.  No ethics committee will wear that.

And suppose it's not drugs (which can at least be put in the back of  
cars)?  Experimental surgery, with a new technique and new gear?  One  
thing in a research hospital with a top-flight surgeon, a top-flight  
gasman and a top-flight set of ICU people to pick up the pieces.  And  
in such a hospital, there can be a fair assurance that the patient  
really has exhausted other options prior to a surgeon trying a tour de  
force new operation.  Is Johnson saying that if they're trialling a  
new technique for, say, paediatric cardiac surgery at Great Ormond  
Street then the surgeon will be expected to knock up a YouTube video  
so the general surgeon at a general hospital can have a crack?  Yes,  
because we need more Bristols.

Alan Johnson.  Proof that post-16 education is useful in a politician.

ian