Clinical supplies & logistics
cohorts their samples on certain days of the week, it opens the door to research bias. “There isn’t any escaping from that – you’ve just messed up right in the beginning. That trial will remain forever doubtful. And that is wasteful,” says Treweek. For Dr Cristina Richie, lecturer in philosophy and ethics of technology at Delft University of Technology, defining the usefulness of a trial is also a broader question of whether a trial is strictly necessary in the first place. “Clinical trials get done on everything from superficial cosmetic procedures like Botox, to life-saving treatments, to things that get financially prioritised, like Covid-19 over Zika,” she says. “We’re already over our 350 parts per million. So, we really need to think: is it worth the carbon?” The figure she cites is considered to be the level of carbon dioxide in the atmosphere that we need to dip below to avert the dangers of climate change.
Low-energy bulbs or lights timed to switch off at night are a simple way of saving energy.
Climate-conscious design
Could changing the way we design clinical trials reduce this impact? Yes, provided we work a bit smarter, says chair of health services research at the University of Aberdeen, Professor Shaun Treweek. “An easy way of making trials more environmentally sustainable would be to not do bad trials,” says Treweek. “It would be to not do trials that are methodologically, extremely poor.” A bad trial is one where the findings aren’t useful to the patient nor to clinicians, he explains.
“An easy way of making trials more environmentally sustainable would be to not do bad trials. It would be to not do trials that are methodologically, extremely poor.”
Professor Shaun Treweek
Of 630t carbon emissions that were caused by electricity during the CRASH trial.
16 39% Sustainable Trials Study Group
Trials like this create waste, as samples, electricity, fuel for travel, personnel hours, data processing and storage are all used in vain. Just 8% of 1,640 clinical trials analysed in a 2022 paper co-authored by Treweek and published in the journal Trials, were “good”. 62% were “bad” and the remaining 30% were somewhere in between. Lower estimates put the cost at £726m, while those on the higher side went all the way up to £8bn. To design a good trial, an important place to start is the research question, Treweek explains. Consider: are you investigating the thing that’s the most important to the patient? And, if this trial is supposed to inform clinical decision making, will it do that? “Far from all trials meet those criteria,” he says. Next, if your trial is randomised, make sure it’s truly random. For example, if you give particular
Reducing patient burden
A clinical trial is no good if too many people drop out of it. To avoid the waste in resources that comes with invalid results or even a cancelled trial, then, it needs to be easy for people to participate. Designing simpler trials with patient needs in mind can boost both recruitment and retention, purely because it’s less hassle for people to get involved, says Treweek. This could mean making scheduling adjustments and only collecting necessary data, for instance. It also results in less work, which means less travel and electricity use, plus fewer wasted samples. “One of the things we routinely do within trials, because we know we’re not very good at retention, is over-recruit,” Treweek adds. To both reach and keep patients engaged, researchers must have a good idea of the factors that would prevent them from taking part in the trial. For example: do they have childcare needs and so can’t do weekends? Are they older and unable to make their own way to the hospital? With these questions answered, trials can be designed with necessary accommodations.
This understanding is especially important when recruiting people who are underrepresented in trials, such as people of colour and those who are socioeconomically disadvantaged, says Treweek. For instance, the idea of being sent drugs in the post to take at home doesn’t necessarily bode well with people of all cultures, he explains. “You need to sit down and have conversations with people to find out how they might be willing to take part in the trial.”
Being energy efficient The 2007 Sustainable Trials Study Group report named electricity as the biggest source of carbon
Clinical Trials Insight /
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