Posts Tagged clinical trials

NO CURE? WHAT ABOUT A CLINICAL TRIAL?

Posted by on Tuesday, 17 September, 2013

bad news

 

 

CLINICAL TRIALS

If you’re not one to take bad news lying down, you don’t have to.

Rheumatoid arthritis, cancer,diabetes, Alzheimers, or migraines. Whatever it is that can’t be fixed. You might be able to get into a clinical trial.

Here in the US, clinical trials  or (“human” trials) are conducted when a new drug or a new device or a new method has advanced to the point where it seems worth trying out on people. Usually, the whatever-it-is worked great on a bunch of animals and the investors are  congratulating themselves on their about-to-be-richness.

They should be so lucky.

Clinical trials are heart breakers.  The hopes and dreams of the developers are often dashed.

But you know what? It’s the subjects of these trials that MISTER ScienceAintSoBad feels for.  It’s their last shot. Nothing else worked. They knew it was just a chance. But still..

YOU AND THE CLINICAL TRIAL

Would I succumb to my fate if there was a chance out there for me? No WAY!!!! I would figure out something! If it hurts, the heck with it. If I have to answer a thousand questions, fine by me. Just let’s get on with it.

If you’re willing to go another round, how do you proceed? Where are these trials? How do you get into them?

This should really be done with your doctor. I would like to think  your doctor would bring up appropriate trials at the right time.  (See below: Why Your Doc Isn’t Much Help With This Stuff).  In any case, a great resource for clinical trials is TrialsCentral.org . It was started  by Kay Dickersin  and a group from The Center for Clinical Trials and Evidence-based Healthcare at Brown University.

A couple of things to remember.

First, be sure you get yourself a second opinion. Your doctor won’t be insulted and will  gladly make some recommendations. Doctors see this as a healthy double check on their work and gladly do it for others when they are called on. If you run out of options – if the second opinion is as pessimistic as the first one – ask your doctor about trials.

Seriously. You shouldn’t  feel you need to do this on your own.

Here’s the thing.

Clinical trials are labeled as phase I, phase II,  phase III or phase IV. Phase I’s where the big problems show up. They’re looking at side effects and what can be tolerated. Enroll in a Phase I test if you want to help the human race. Enroll in something else if you want to help yourself.

Phase II’s where thing’s get more interesting. This is where we’re starting to figure out “efficacy” and trying to figure out what’s the right dose.

Phase III trials are often the big expensive ones. This is where people are  recruited in various locations around the country. They’re the make/break tests for approval by the FDA.

 

BEATING THE DISEASE

If you’re looking for a “miracle” (the quotes aren’t there to make fun – just something you do when you’re Mister ScienceAintSoBad) you’re interested in Phase III trials. But. remember, even in a phase III trial there’s a good chance you may be placed in a control group, meaning that you don’t get the drug or its benefits. And trials are EXPERIMENTS. They’re risky. You might have a better (short) life if you just carry on.

Don’t  forget that you may be able to argue for “compassionate use” (single patient access) meaning, I’m not about proving anything just hand over the drug please.

Not EVERYONE wants to die for science. This might work best if the trial subjects are already enrolled.

 

 WHY YOUR DOCTOR ISN’T  MUCH HELP WITH THIS STUFF

Well most doctors  COULD get you hooked up with a clinical trial – one that offers some new hope. But they probably won’t. Denise Mann (Web MD) says most patients who could qualify for clinical trials, won’t even hear about them from their own doctors.

This doesn’t mean doctors don’t care. The ones I know and the one’s I’ve worked with are amazing. They work hard and they’re usually very smart. But they’re human, okay? Just so many hours in a day. Just so many dollars in a paycheck. They can’t be everywhere. Can’t do everything. Gotta go home sometime. And this has a lot to do with why they’re shy about introducing their patients to clinical trials. Keeping up with 8,000 trials is SLIGHTLY impossible. When would that “keeping up”  happen? Before 5 AM? Or after 2 PM? Medicine is intense. The hours are long and the stakes are high. And there’s a lot of required reading just to stay current in day-to-day practice.

Also, there’s the relationship with you.

Maybe a particular clinical study does offer  a shot (usually a long one).  It probably means the patient’s off to some distant place at a time that is emotional horrendous for him.her.  And the patient and the doctor have an established  relationship. Believe it or not, separating from the doctor  can be tough for both the patient and the physician.

INVESTIGATE EARLY

People, naturally, do the regular stuff first. If things don’t work out, maybe they start looking around for something a little bit crazy. Most people see clinical trials as  extra innings  (a little baseball metaphor here).Well that could be too late. Some of these trials won’t let real sick patients into their programs. They need to get at them earlier.

Even though I don’t know you, I just want you to know that I sincerely hope you will get better and get your old and wonderful life back.

 

 MisterScienceAin’tSoBad would never, knowingly, give you any bad advice or misinformation but biomedical engineers don’t treat patients and shouldn’t give medical advice. This is the best information I have but but where your health’s at stake, please get a second opinion on my own words, okay?

 

——————————————————–
The cartoon is mine

 


WHAT? NOTHING AFTER CHEMO?

Posted by on Thursday, 7 July, 2011

Dear MISTER SASB: My grandmother’s got stomach cancer. She’s had surgery, drugs, and chemo. Now the doctor says she should get hospice care which totally (if it’s okay to say) sucks big time. Grannie taught me to read and to ride a bike and even how to cut cocaine. There MUST be something they can do! –  Nancy Trill

Dear Nancy:

It sounds like yer granny could open up her own pharmacy.

Anyway, to answer your question, her Docs COULD get your granny hooked up with a clinical trial that offers some new hope. But they probably won’t. Denise Mann (Web MD) says most patients who could qualify for clinical trials, won’t even hear about them. At least, not from their own doctors.

This doesn’t mean doctors are a bunch of bums. The ones I’ve worked with (and consulted) are almost uniformly terrific. They work hard and they’re, mostly,  very smart. BUT they are human (surprise!). Just so many hours in a day. Just so many dollars in a paycheck. They can’t be everywhere. Can’t do everything. Gotta go home sometime. And this has a lot to do with why they’re shy about introducing their patients to clinical trials. Keeping up with 8,000 trials is SLIGHTLY impossible. When would that “keeping up”  happen? Before 5 AM? Or after 2 PM? Medicine is intense. The hours are long and the stakes are high. And there’s a lot of required reading just to stay current in day-to-day practice.

Also, there’s the relationship thing.  Maybe a particular clinical study does offer “a shot” (usually a long one). Still. It probably means the patient’s off to some distant place at a time that’s infinitely crappy and emotional horrendous.  And the patient and his.her doc often have a thing going, a doctor patient relationship. Believe it or not, separating from the Doc who took the patient this far down  Dismal Road  can be tough for both the patient and the physician.

INVESTIGATE EARLY

People, naturally, do the regular stuff, first. If things don’t work out, maybe they start looking around for unregular stuff.  It’s tempting to see clinical trials like the extra innings. After the first nine. (A little baseball metaphor here.) Well, sorry, Bub, but that may be too late. Some of these trials won’t let patients who are practically gonners into their programs. They need to get at them earlier in the progression of the disease.

THE RIGHT ANSWER

You’re kidding, right? If I knew the right answers to this stuff, do you think I’d be sitting here cranking out blog articles? I don’t know how to get doctors back into this loop either.  But something’s gotta change. That’s for sure. It’s not right to expect patients, on their own and at the worst possible time in their lives, to become medical detectives, capably sorting through the relevant research. And it’s not like NO doctors are referring to clinicals. Maybe we need to understand what the doctors who get this right are doing.

Mister ScienceAintSoBad‘s an optimist. He thinks things will improve.

Sooner’s better than later.

0———————0

Credit for above cartoon (which I don’t exactly understand either) to, xkcd.


CLINICAL TRIALS LIKE CRAZY

Posted by on Friday, 17 December, 2010

DOCTORS CAN BE VERY REASSURING (1906)

THE GOOD

Life’s good, right? You’re very loved.

Money? Enough. Who needs more? Besides. Money’s not what counts. Summers are warm. Winters? Crisp. With snowball fights, skiing, and frosty branches glistening in front of the window.

It’ll always be like that. Nothing bad’s gonna happen. I Promise.

THE UGLY

Just in case my spell doesn’t work, here’s a resource. It’s for when somebody gets sick.

Very sick.

So sick that he or she runs out of options and the Doc, so optimistic and reassuring at first,  looks uneasy and emphasizes the need to be realistic. This is a place to go that’s out beyond the end of the road. Maybe it’s the next road. It’s called TrialsCentral.org . It was started  by Kay Dickersin  and a group from The Center for Clinical Trials and Evidence-based Healthcare at Brown University.

Couple of things to remember.

First, be sure you get yourself a second opinion. You’re not being disloyal. It’s a routine part of medicine. Your doctor won’t be the LEAST bit uncomfortable. He or she will be glad to make some recommendations. In fact, your Doc will also help you go over the possibilities for possible clinical trials.  You shouldn’t  feel you need to do this on your own.

Clinical trials are labeled as phase I, phase II,  phase III or phase IV. Phase I’s where they weed out the REAL stinkers. They’re looking at side effects and what can be tolerated. Mostly, they’re not looking for sick people anyway. Phase II’s where thing’s get a little more serious. They’re starting to figure out “efficacy” and trying to figure out what’s the right dose. Phase III’s where they get to spend lots of money recruiting subjects in trials in various locations around the country. These are the make/break tests that determine if it gets approved. The phase IV trials are kinda “tune ups” that’re done on drugs that are already out there.  (There are also “phase 0” trials – ultra cautious tests on a few people. A sanity check to make sure they’re ready to do the Phase I stuff).

STUBBORN ENOUGH TO LIVE

If you’re looking for a miracle (am I mixing metaphors?) you’re interested in Phase III trials.  But. remember, even in a phase III trial with a very promising drug there’s a good chance you may be placed in a control group, meaning that you don’t get the drug or its benefits. And trials are EXPERIMENTS. They’re risky. You might have a better (short) life if you just carry on.

But you’re a gambler, aren’t you? You’re not gonna go unless you HAVE to. And you’re damn well not gonna go without a fight. Well don’t  forget that you may be able to argue for “compassionate use” (single patient access), meaning screw the science, just the drug please. Not EVERYONE wants to give a life for science.

Just a small footnote. (Well, I have to say this.) MisterScienceAin’tSoBad would never, knowingly, give you any bad advice or misinformation, but biomedical engineers don’t treat patients and don’t give medical advice. I do offer the very best information that I can but where your health’s at stake, you’ll want to verify anything you read here.

——————————————————–
Attribution for above image: By Anonymous [Public domain], via Wikimedia Commons