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Clinical trials and the missing results


We are in election month and one of the recurring themes is whether or not we can trust our politicians to speak the truth. We want full, honest and transparent information from those who are going to steer our country through the challenges in the next few years.

The same applies in our clinical practice. One of the biggest challenges is trying to make sense of all the messages around us in order to work out what is the best possible care we can offer our patients. These days, there seems to be a general acceptance that evidence-based practice, which seeks the best possible evidence to inform clinical practice, is the best way forward. We know our patients are all individuals and not everyone responds in the same way to the same treatment, but let's at least start with the treatment that good quality research has shown to have the best possible chance of success. 

If we are seeking to establish 'what works' then the best type of research to answer this question is a good quality clinical trial (ideally a randomised trial). Better still, if there are a few good quality trials asking the same question, then these can be used to populate a systematic review to provide an even higher level of evidence to guide our practice. Lots of clinical trials are undertaken but the shocking thing is that there is no legal requirement to publish the results. Think about it - if you only ever get to read about trials where the results favour the views of whoever commissioned the study, then you only get access to some of the information, not the whole picture. This means that your clinical decisions will be based on incomplete and potentially flawed information and this can seriously harm patients. What is really frightening is that there is good evidence that only about half the clinical trials that have been undertaken have reported their results.1 That is an awful lot of missing information! Ben Goldacre makes this point very eloquently (and accessibly) in his TED talk on the topic.2

The AllTrials campaign1 has worked to change this for some years and are starting to make some progress. Recently, for the first time ever, the World Health Organisation (WHO) has said that researchers have a clear ethical duty to publicly report the results of all clinical trials including previously hidden trials. The next step is to call on the government, the healthcare industry and healthcare professionals to follow this WHO recommendation so we can have some honesty and transparency. Those of us in clinical practice and academia need access to this hidden information if we are going to help our patient make the best possible judgements and decisions for their health.

Please think about signing the AllTrials petition to add your name to the campaign for full information.