The emotional trial of clinical trials: like online dating with death risk

Post by s1artibartfast » Tue, Apr 23, 2024, 3:56 AM UTC

timr wrote: post #101

s1artibartfast wrote: post #88

Earlier quoted context omitted.

None of this data will be published for a phase 1 study, but each participating doctor should have a copy of the investigators brochure, which contains all the preclinical data and clinical data up to this point. If you are taking a commercial medicine, the first place to check is the "prescribing information", which is publicly available and has all of the trial data, adverse events, efficacy, toxicology, interactio…

Regardless of the validity of the "user manual" metaphor, it's a pretty thin manual. At the phase 1 trial, you basically have some data from cell lines, mice and other small mammals, and maybe a few early humans. You can't infer much of anything from that. To a first approximation, about half of drug candidates fail in each phase of development (i.e. 50% drop off in every phase, from 1 to 3). Naïvely, then, about 80%…

Post by s1artibartfast » Tue, Apr 23, 2024, 4:09 AM UTC

timr wrote: post #99

jseliger wrote: post #93

Earlier quoted context omitted.

Tell people that you don't know the answer I should probably clarify that point; oncologists are often dealing with small numbers and a lot of uncertainty. I'm also not sure how much they're supposed to say—I don't see the NDAs or other docs they sign with drug companies. That said, if they see tumors shrink in at least some patients, that's pretty good. I also have recurrent and metastatic squamous cell carcinoma or…

> I'm also not sure how much they're supposed to say—I don't see the NDAs or other docs they sign with drug companies. That said, if they see tumors shrink in at least some patients, that's pretty good. I mean, that's all they have to go on, so it's all they can say. But it's a long way from any sort of proof, and they really should only be saying "we don't know, and you're taking part in an experiment to find out".…

Post by bruce511 » Tue, Apr 23, 2024, 4:41 AM UTC

danielheath wrote: post #87

timr wrote: post #85

Earlier quoted context omitted.

Yes, that's true. There's some question here (the author talks about debating whether to do another round of chemo to shrink the tumors, or to try to get into a trial), but ignoring that, I'm certain that people view it this way. It doesn't excuse the doctors for not being direct about the choices at play: you are trying to get into an experiment where there's a 50% chance you'll get the same treatment you'd get anyw…

> You're not doing it to survive. If the currently-available treatments mean I'm going to die, "try something that might kill me or cure me" is absolutely a thing I would consider "to save my life".

Post by datascienced » Tue, Apr 23, 2024, 5:31 AM UTC

refulgentis wrote: post #71

data_maan wrote: post #29

The issue with the medical system is similar to the issue with prisons: It has no person that is motivated to care about it. If you are an inmate, or a patient you're just happy once you're out, and don't want to spend more of the time to fix. And if you're a free or healthy person, why devote time to something that will likely not concern you? (It might some day, but few people are reflecting enough to realize this.…

Frankly, I can't subscribe to this jaundiced viewpoint. They're going to great lengths to make rolls of dice. The unspoken is just as important as the spoken here, it's framed as maddening dashes through confusing red tape for crucial medical treatment, but truth is, it's grasping for agency in place you aren't supposed to have any in the face of the ultimate agency-remover. You can easily walk away from the article…

Post by CogitoCogito » Tue, Apr 23, 2024, 5:41 AM UTC

s1artibartfast wrote: post #105

timr wrote: post #103

Earlier quoted context omitted.

Well, first: I didn't say anything about anyone being "less than candid". I don't believe that, or at least, don't have any reason to believe it from this post. I think people are talking their books, being overly optimistic, or just plain being arrogant. Second: regardless of what the author understands or does not, the quotes about oncologists pointing to their favorite trial, and the like, are not OK. The only val…

I vehemently disagree that doctors should remain silent on their opinions. I think doing so would be very unethical and deceitful, by way of omission. However, they should be clear on what is option vs established consensus