[Professor Paul Glasziou]
At the end of my medical training, when I was out there doing medical work, I was interested in answering uncertainties in medicine. The physician might say one thing is the right treatment, and the surgeon would say the surgical treatment was the right treatment for this. And I'd say, but you're both arguing from different mechanisms. How do I decide which one is right? And that eventually led me into discovering about the use of clinical trials to answer every day clinical questions. The modern era, what we classed as a clinical trial really begins with antibiotics.
At the end of World War 2 they conducted what's called a randomised trial where they gave some of the patients the antibiotics and some not, and discovered they did much better when they got the antibiotics. It's flourished ever since then. We now have hundreds of trials published every year. There's a broad set of questions that you can answer with clinical trials, not just drugs. You can answer questions about non-drug therapies to help with glue ear, but also just management questions. For example, blood glucose monitoring. If you're not on insulin and you're a diabetic patient, is it a good idea to regularly, every day monitor your blood glucose or not? And it turns out when we randomised people to do that or not, to the experienced patient who was already managing themselves reasonably well, the routine doing of it didn't actually help. So that's not a drug question, it's a question about the everyday management of a condition.
So, some of the more recent ones were the advanced trials run from the George Institute in Sydney. A lot of the problems that diabetics suffer from are heart disease problems that are treatable with blood pressure lowering. And so, patients were randomised to different types of interventions, and it turned out that more intensive glucose control didn't actually help, whereas the more intensive blood pressure lowering did. Which is quite a surprise because you think, well, diabetes, the treatment is about glucose, but actually blood pressure lowering was better for controlling your risk.
When I was working in Oxford, we had analysed all of the small trials that had been done up to that point to try and treat glue ear, and they weren't particularly good. We said a big trial needs to be done looking at the use of a nasal balloon to try and force air up into the middle ear and open up the eustachian tube, the connection to the nose and drain properly. And that showed that this simple technique of blowing up a balloon with your nose worked to treat glue ear in kids. And the only reliable way you choose what the right thing to do is, is to do a clinical trial.
Probably the best example of this is in trying to treat kids with leukaemia. People kept having good ideas about what should be better, and so it was trialled against the best current therapy. When they found one that did work, that became a next standard therapy. Over a period of about 30 years, leukaemia went from a universally fatal disease to 80% of kids now have long term survival, and it wouldn't have happened without the clinical trials community.
Now I’d highly encourage patients to be involved in trials. I think it's mostly altruism. They get to be involved in helping the next set of patients do something better. They'll get more information. They are working with the two best possible therapies, for example, usually, so they'll get a higher quality care in general when being involved in the clinical trials.
Medicine mostly doesn't advance through breakthroughs. They're really rare. Medicine advances in little steps, and the clinical trials allow you to make those little steps that lead eventually to that big advance. If you don't have the clinical trials, you can't tell which is the advance and which is going backwards. I think we have to get all health professionals to be engaged in the idea that clinical trials are a necessary component of all health care. So, on all levels of the healthcare system, you can make improvements. And that it's not just about drugs, it's about non-drugs, It's about the choices in management, the choices in organisation. All of those can be assessed through clinical trials.
After my medical training when I was doing clinical work, I was interested in how we answer uncertainties in medicine. I serendipitously discovered that clinical trials were the best way to answer our everyday clinical questions.
Medicine mostly doesn't advance through breakthroughs - they're really important, but really rare. Mostly medicine advances in little steps. The clinical trials allow you to guide those little steps that eventually add up to a big advance. But if you don't have the clinical trials, you can't tell which new treatment is the real advance, and which is going backwards.
We have to get all health professionals to be engaged in the idea that clinical trials are a necessary component of all healthcare. So at all levels of the healthcare system, we can make improvements. That improvement is not just about drugs, it's about the choices in management and the choices in the organisation of care. All of those can be assessed through clinical trials.