OncologyIs It Legitimate To Stop Clinical Trials Early On Account Of Their "Opportunity Costs"?
A provocative debate in this week"s PLoS Medicine examines whether it
would be legitimate to stop a clinical trial of a global health tool early
in
order to reallocate the res to testing newer products.
After the failure of three large clinical trials of vaginal microbicide
candidates (chemical agents aimed at preventing HIV infection), a 2007
editorial in Nature stated that the microbicide field "requires a
mechanism to help it make rational choices about the best candidates to
move
through trials." In the PLoS Medicine debate, James Lavery (University of
Toronto, Canada) and colleagues propose one such mechanism, based on
stopping trials early for "opportunity costs." They argue that microbicide
trial sites could have been saturated with trials of scientifically
less advanced products, while newer, and potentially more promising,
products were being developed. They propose a mechanism to reallocate
res
invested in existing trials of older products that might be better
invested in more scientifically advanced products that are awaiting
clinical
testing.
But countering Lavery and colleagues" proposal, David Buchanan (University
of Massachusetts, Amherst, USA) argues that stopping trials early for
such opportunity costs would pose insurmountable practical barriers, and
would risk causing harm to the participants in the trial that was stopped.
Funding: James Lavery and colleagues" article was funded by a grant from
the Bill & Melinda Gates Foundation (BMGF) to Drs. Singer and Lavery.
Lavery and colleagues presented an earlier version of their ideas at the
BMGF, and feedback was taken into consideration in revisions of their
paper.
Peter Singer is also Sun Life Financial Chair in Bioethics at University
of Toronto. The funders had no role in the decision to submit the
manuscript
or in its preparation. David Buchanan received no specific funding for his
article.
Citation:
"In Global Health Research, Is It Legitimate To Stop Clinical Trials Early on Account of Their Opportunity Costs?"
Lavery JV, Ridzon R, Singh JA, Slutsky AS, Anisko JJ, et al. (2009)
PLoS Med 6(6): e1000071. doi:10.1371/journal.pmed.1000071
Plos Medicine