tag:blogger.com,1999:blog-32053362.post8224288024972283526..comments2024-03-26T00:25:34.026-04:00Comments on Not Running a Hospital: Research mattersPaul Levyhttp://www.blogger.com/profile/17065446378970179507noreply@blogger.comBlogger5125tag:blogger.com,1999:blog-32053362.post-41029783483060382212010-10-24T14:26:15.753-04:002010-10-24T14:26:15.753-04:00Just a brief comment from someone who works at a m...Just a brief comment from someone who works at a major research center in the midwest. Of course there is going to be the occasional researcher who is a touch overzealous in their patient recruitment activities, but effective human research protections training programs and ongoing educational opportunities go far to help alleviate this issue. Most researchers are ethical, and strive to perform research in the appropriate way, including working towards performing fully informed consent. Research coordinators also are highly participative in this process, and can be a great resource to ensure this is happening. Additionally, when working with patients the oncologist in charge of the patient's care should be addressing issues of palliative/hospice care - not necessarily the researcher/PI. Much could be done in this area outside of the research mileu; helping patients and families to understand the reasons for palliative care services - something that is sometimes a taboo topic. Mr. Levy's post regarding the actions taken in response to the recent issues is encouraging, as they indicate the organizations' willingness to address the issue openly.Carrie Catanzaronoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-46572801018396101972010-10-22T05:45:11.252-04:002010-10-22T05:45:11.252-04:00My earlier comment suggesting that cancer treatmen...My earlier comment suggesting that cancer treatments should be subject to rigorous cost-benefit analysis and QALY metrics referred to FDA approved cancer drugs, NOT experimental drugs used in cancer trials. I have no problem with research driven cancer trials as long as doctors fully inform patients about likely side effects and respect the wishes of patients who might prefer to move into hospice or palliative care after their disease has reached a late stage and the prognosis is poor. My sense is that many times doctors hold out false help for patients with late stage, aggressive cancer because they are anxious to recruit them to enroll in drug trials.Barry Carolnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-88080017188679317852010-10-21T11:34:46.348-04:002010-10-21T11:34:46.348-04:00Let me preface the following comment by stating cl...Let me preface the following comment by stating clearly that I am a full supporter of CER and QALYs for many medical procedures and treatments of chronic diseases. That said, Barry Carol's comment sent shivers down my spine! QALY metrics for cancer trials? <br /><br />CER and oncology are usually a very, very bad match! You cannot develop QALYs when the total population of patients suffering from a disease is small. And, as we learn a bit more every day, most cancer patients are suffering from a rare disease, one that may be with n=1. <br /><br />Please do not try to push the tyranny of data in every direction, without fully understanding the most current science of medicine. Putting the future of oncology research in the hands of QALY experts may save lots of money but will cost many lives. <br /><br />Following the recurring problems created by the NICE decisions in oncology, one cannot honestly ask to blindly implement QALY metrics in oncology.Unknownhttps://www.blogger.com/profile/16776267069259528557noreply@blogger.comtag:blogger.com,1999:blog-32053362.post-84837192686029998492010-10-21T10:50:25.589-04:002010-10-21T10:50:25.589-04:0066% of our research budget is from NIH and other f...66% of our research budget is from NIH and other federal agencies (mostly NIH). I'm not sure of the cancer percentage.<br /><br />Your concerns are meant to be addressed through a very, very rigorous IRB review process, eligibility requirements, and the like. Others, more knowledgeable, can comment on the efficacy of those, but my impression is that they work well to address the issues you raise.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-47320358347164841812010-10-21T10:37:08.036-04:002010-10-21T10:37:08.036-04:00I’m curious to know how much of your research budg...I’m curious to know how much of your research budget is funded by NIH grants and how much relates to cancer research including clinical trials.<br /><br />It seems that there is lots of potential for conflict of interest in cancer research. I wonder, for example, about the temptation among oncologists involved in cancer research to overstate the potential of an experimental drug to help a late stage cancer patient for whom established treatments were not successful. Have patients been fully informed regarding potential side effects and likely quality of life even if their lives are extended somewhat? To what extent are the patients’ stated wishes, if any, regarding end of life care taken into account? <br /><br />Successful trials are exciting and rewarding and can advance the careers of academic researchers. Also, while the experimental drugs are provided at no cost to the patient, other medical costs (hospital, physicians, etc.), which are expensive, still need to be paid for by insurers and/or the patient and the family. Even when clinical trials are successful and lead to FDA approval for a new cancer treatment, the cost of a course of treatment is extremely high for often little more than a few weeks or months of low quality life. If there is an area of healthcare that should be subject to rigorous cost-benefit analysis, including QALY metrics, to determine what will be paid for and how much, it’s cancer treatment. Just my opinion, of course.Barry Carolnoreply@blogger.com