Medical research in 'perilous state'

Medical research in Canada is funded disproportionately at a low level, say doctors calling for more efficient clinical trials.

Randomized controlled trials involving thousands of people are the gold standard way to test if treatments save lives.

In a classic example,giving Aspirin to prevent heart attacks was overlooked until clinical trials provided the value. The research is also important in showing how widely used treatments like using hormone replacement therapyin postmenopausal women can be harmful.

The Canadian Institutes of Health Research (CIHR) should increase funding for randomized trials from 3.3 per cent to 10 per cent of its overall budget within five years, investigatorssay in an essay in this week's issue of the Canadian Medical Association Journal.

Dr. Salim Yusuf of McMaster University in Hamilton and Dr. John Cairns of the University of British Columbia said the studies should include evaluations ofdrugs as well as surgical and behavioural treatments.

The CIHRprovided about $1 billion in research funding in 2010-2011, which equals about$29 per capita. In comparison, the U.S. spent $100 per capita and the UK provided $45 per capita, the authors said.

Both the AmericanandBritish governments have shifted the proportion of funding they provide to clinical trials but Canada hasn't, they said.

Research participants reap benefits first

"The CIHR should sharply increase funding for peer review for clinical trials," the authors said.

"This shift could happen within the next four to five years and grow to 15per centof the total CIHR budget to ensure that the clinical relevance of discoveries from other forms of [laboratory] research can be rapidly assessed."

Quality is not an issue, they said, noting Canadian trials ranked second to the U.S. and ahead of England, France, Germany, Australia and Japan in a 1998 report in the journal Nature.

The authors gave several reasons to support their call to strengthen the "perilous state" of randomized trials in Canada, including:

• The first citizens who participate in clinical trials are often the first to benefit, as was the case when Canadians with a history of transient ischemic attacks were the first patients to benefit from reduced stroke and death with Aspirin.
• Some questions can only be settled in a Canadian setting, such asthe firstclinical trial showingthe safety and effectiveness of nurse practitioners providing primary care.
• Economic benefits.
• Social and moral obligations to poorer countries.

The pair also saidsome of the bureaucratic and administrative barriers that hindertrials in Canada, such as overly complicated consent forms,need to be removed.

The CIHR could also leveragefunds through partnerships with other funding groups, health charities and universities, the authorssuggested.

Funding for basic sciences should be kept at current levels, they said.