i saw this interesting news. and i extract from http://meltwaternews.com/prerobot/sph.asp?pub=ST&sphurl=www.straitstimes.com//PrimeNews/Story/STIStory_484743.html
TEACHER Alvin Chew wonders if his
father, who died of blood cancer last year, would still be alive
today if he had been admitted to a clinical trial. Such trials
sometimes allow patients access to drugs that have yet to be
commercially available.
As medical care in Singapore
improves, its attraction to large pharmaceutical companies needing
to carry out fast and high-quality studies of their new medication
has gone up as well.
This gives patients here a chance
at cutting-edge medicines that could make a difference between
recovery and death.
But as Mr Chew, 39, found out, it
is not easy for a patient to learn about such trials. He had asked
the oncologist about such trials, when his father was not
responding to the standard treatment. But the private doctor was
not very helpful.
That is not surprising, since the
majority of such trials are done in the public sector. It is
possible that the oncologist was not aware of the relevant trials
that were being carried out here, since the information is not easy
to come by.
This is unlike the situation in
countries like the United States, where all clinical trials are
listed. A clinical trials registry provides information on what the
purpose of the trial is, who is heading it, where it is being done,
who may participate, and a phone number for people to
contact.
Here, the Health Sciences
Authority (HSA) says such information is confidential. It will give
only overall figures of the number of trials it approved each year,
and the general type of diseases involved.
So we know only that there were
286 trials approved in 2008, of which a third were for cancer. But
we do not know what types of cancer they were, who was conducting
the trial and if they were still recruiting patients.
Should Singapore have a similar
website, allowing patients and doctors alike access to what is
going on in the clinical trials scene?
Mr Chew certainly thinks so. He
said: 'It's ironic and saddening to know that Singaporeans who may
benefit from these drugs are not given the opportunity for these
treatments because of ignorance on their part and because such
information is not made available publicly.'
Both Associate Professor Goh Yeow
Tee, director of clinical research at Singapore General Hospital,
and Dr Robert Lim, head of haematology-oncology at the National
University Cancer Institute, agreed that a local list might
help.
Said Prof Goh: 'Listing on a
national or institutional website is a good idea as it would
increase public awareness about the availability of trials and
participation in trials.'
But Prof Goh also pointed out that
all trials of significance are already listed on the US website
www.clinicaltrials.gov
A check by The Straits Times found
the site lists 84,458 trials in 171 countries. While some of the
Singapore trials mentioned come with full information, others do
not even give the name of the principal investigator or a number to
contact. Not much help to the average patient.
Dr Lim added that the US site does
not list trials that are initiated by doctors here. It is therefore
not comprehensive.
On the other hand, a local list
helmed by the HSA could provide the public not just with a list of
trials, but also other relevant information such as the benefits of
taking part in trials, what the exact criteria are for patient
selections, and how they can take part. Such a list would serve
several purposes.
First and most importantly, it
would allow patients here to find out if there are any trials that
could help them - when conventional treatment no longer
works.
It would also promote Singapore as
a medical hub of note, since trials are usually carried out in
places with good clinical practices in place. It lets foreign
patients know what is available here and gives them the option of
coming to Singapore for treatment.
It would also help doctors
involved in such trials to recruit patients expeditiously. Dr Lim
said that among the hurdles facing trials is getting the right
patient population and getting sufficient numbers of
patients.
As Professor Soo Khee Chee, head
of the National Cancer Centre, said, every day's delay in reporting
results of a trial costs a pharmaceutical company US$1 million
(S$1.4 million). Faster recruitment of patients and quicker trial
completions might see more high-quality trials coming this
way.
As it is, between 2,000 and 3,000
patients are roped in for such trials each year. More trials done
here will help even more patients. They will not only get access to
drugs that have yet to hit the market, they could also save some
money as the cost of the treatment is often borne by the
pharmaceutical company conducting the trial.
St Jude Children's Research
Hospital in the United States has an enviable 90 per cent survival
rate for children with leukaemia or cancer of the blood. Its
patients reportedly have a 20 per cent survival advantage over
other hospitals.
A major reason is that almost all
its patients are on trials, with access to the latest medicines
being tested for this range of disease.
While Prof Goh agrees that a
national listing would increase public awareness, he, like the HSA,
is concerned about confidentiality over who is sponsoring the trial
and the drug in question.
However, these are not problems
that are insurmountable. At the very least, the information given
on the US website should be available here, since it is already in
the public domain.
All this would entail a little bit
more work for the HSA, perhaps, but the benefits both to the nation
as well as to patients would certainly justify the
effort.
can clinical trials really
save?