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I think there would be difficulty just to get enough willing participants out of the 5%. I suspect that group at this point has to be the most extreme skeptical holdouts or religious objectors and would likely be adverse to any clinical trials.


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One issue I'd could imagine is that it might be difficult to slice a representative sample out of those 5% of people, whereas a clinical trial is set up from the get-go to enroll individuals that would make up a representative sample of the intended recipients of the drug/procedure/device that's being studied.

It would be hard to convince me to sign up for such a study, if there’s a 50% chance they give me a placebo and I die.

Also, there’d be significant ethical issues with trying to prove that some long-used treatment works. There’s really no way to get a control group.

The same kind of people who already enroll in any other kind of drug trial. "Who would volunteer for that study" doesn't make much sense of a question considering people are willing to do phase 0 studies of new drugs which are theoretically far more dangerous.

Thanks for the article, however I have a problem with a lot of these trials. The number of test subjects. A couple of hundred I feel is not enough people, and half of those dropped out. We need thousands of test subjects from different age ranges and in different states of health for more accurate data.

I signed up as a volunteer on 1DaySooner and have to imagine that public support would be for human challenge trials. Limiting it to those under a certain age and who are in good health seems like a no-brainer.

While I understand health professionals across the board hesitancy to push for such things, doing so in this case would border on zealotry.


What do you think the solution would be, should this take off? Wrapping early stage trials in a veil of secrecy?

I think most people would prefer a study with more participants, but you can’t jump to a large human trial right away

While I totally get what you mean, I’d guess for scientists, the answer is generally, “no”. Expected outcomes for trials like this are a whole lot less certain to the people doing the work, that than it seems on the outside, so i think it wouldn’t even occur to the scientists that the downside of “withholding” treatment from the tiny (relative to the population) control group comes close to the upside.

It'd be a logistical nightmare to setup validated testing and so on for tens of thousands of participants.

The studies coming out that did regular testing focused on easily reached populations (medical workers) that may not have been representative of the wider population (so not suitable for the trials).

https://www.nejm.org/doi/full/10.1056/NEJMc2102153

https://www.nejm.org/doi/full/10.1056/NEJMc2101927


What happened to the other 20%? If this is the part of the population that is resistant to the trial, then good luck in the coming years.

Ideas like this seem to me to be often based on a vast overestimation of how likely a drug candidate is to work. Something like 90-95% of drug candidates in the preclinical phase fail. And even if we go to the latest stage, phase III clinical trials, there is still a 50:50 chance that they won't work.

Another issue is that the rich people likely wouldn't be happy with the chance that they're in the placebo group. So they probably would have to be guaranteed to get the real drug, outside of the actual trial.


The clinical trials have been for months on limited numbers of people. Given this seems to be a 1 in a million situation the odds are against those trials discovering them.

to be clear, I think I'd be even more comfortable with some sort of socially accepted procedure to sign up for really experimental trials done by some non-profit seeing entity. Some sort of procedure where you get several conventional doctors to sign off on, you know, that conventional medicine isn't going to cure you, then sign up for something that looks good, but hasn't been fully tested yet.

I'm just saying, going to a for-profit entity and saying "give me something experimental" and then paying the same on success or failure seems like a pretty bad idea to me.


Randomized trials would be difficult...

I wonder if you could run a paid study with a proper control group. Perhaps have everyone pay to participate, administer the treatment to half of them, and at the end of the study refund some amount of money (all? all + interest?) to the ones who received a placebo. That way they've only donated their time.

It would suck to be included in the trial and then be randomly selected into the placebo group.

We've got tons of clinical trials going on. None of them have worked so far, but nevertheless, we spend billions experimenting on humans, and trials are always looking for volunteers

It's a semi common issue for highly effective novel treatments. In order to continue the study you need to keep some portion as a control group.

I can't imagine wanting to keep people in the control group when the experimental treatment is so dramatically effective.

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