Martin Leon Barreto

HUNDREDS of years ago, if you had a pain, a cough or a fever, an apothecary might prescribe you a tincture or – joy – a restorative course of leeches. Thankfully, medicine has come a long way since then. It is by no means perfect, but hospitals, drugs and healthcare have made our days inestimably more comfortable.

Much of this is thanks to that bastion of science, the clinical trial, which tests whether a medicine or treatment is safe and effective. Evidence from such trials is considered the gold standard, and over the years it has helped us sort the quackery from the cures. It might be surprising to hear, then, that a growing number of doctors think the way we test medicines needs an overhaul.

For all their strengths, clinical trials often take years to deliver a verdict. This drawback was exposed during the covid-19 pandemic, when we desperately needed treatments for a new disease. Doctors were forced to use quicker methods of assessment, and at this juncture, it seems they paid off. “We were able to achieve in weeks what would have otherwise taken years,” says epidemiologist Martin Landray at the University of Oxford.

If we can get robust answers about medicines in a faster way than standard clinical trials can, surely we are ethically obliged to do so. Some say yes: helping more people more quickly must be a good thing. Others worry that rushing medicines into use has got us into trouble before. Whether there really are speedier, more reliable ways of doing clinical trials is rapidly becoming one of the most critical questions in medicine. …

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