- Derek Lowe: The Best Ideas Are Not Always Enough.
Drugs which look great in those cellular machinery flow charts with boxes and arrows pointing every which way, and which may even cure a few genetically monstrous and wholly artificial lab mice, tend to flop where it matters. Lowe links to 11 such examples and writes in more detail about the twelfth.
- Adam Kroetsch: Why clinical trials are inefficient. And why it matters.
An overly long article ᔥNintil with which I don’t completely agree For example, Kroetsch describes the role of a site investigator as resembling “that of a glorified data entry clerk - the investigator’s primary responsibility is gathering the data that the drug company needs and sending it to them”. This is incorrect: site investigators usually have clinical research coordinators and data managers to do it for them. But this deserves a post of its own. but which nevertheless provides a good overview of the many things wrong with how clinical trials are being conducted in the US, the biggest one being that they are reinventing the wheel each and every time they are done. The “lean trial” proposal at the end matches my own thinking.
- Ruxandra Teslo: A response to Dario Amodei on AI & clinical trials.
Teslo picks up on the tech bro magical thinking streak in which things you don’t sufficiently understand seem eminantly solveable using the most recent technological developments. Five years ago it was electronic medical records and blockchain, now it’s clinical trials and AI. The article gives the many reasons why things are not that simple. Now, if we all agreed on the set of LLM prompts that would provide an unbiased protocol and informed consent form review thus eliminating as many people from the loop as possible, well, then we may be on to something.
If someone qualifies for euthanasia, should they also not be eligible for every expanded acces, compassionate use, right-to-try scheme imaginable? Obviously: yes. Maybe not so obviously: there is a branch of my subspecialty aptly named desperation oncology which in the vast majority of cases leads to false hope, financial ruin and, worst of all, time misspent in doctors' offices and infusion clinics instead with your loved ones. As a doctor and a human being I am partial to life, so I see state-assisted dying programs like Canada’s MAID as monstrous, but “you’d rather be dead so here, take this drug” is only a half-step above that qualifier and leads to the bad reputation of experimental therapies.