Rough day

No time today to continue my project of Thinking Deep Thoughts, it will return tomorrow. I spent most of the day at a symposium on access to cancer clinical trials for minorities, where I facilitated a workshop. An interesting subject though a bit more complex, in my view, than many of the other participants see it. African Americans, Latinos, Native Americans are all grossly underrepresented in clinical trials of cancer treatments. That should not be.

On the other hand, it isn't quite accurate to view access to trials as a benefit to the individual patient. The principal of "equipoise" means that in order for a trial to be ethical, we really have to not know whether the experimental treatment is better or safer -- or worse or less safe -- than the standard treatment. The only time access to trials is really a benefit is when people are terminally ill and standard treatments have failed; then, you might as well go ahead and try something. This is the situation in so-called Phase II trials, which are small and intended mostly just to establish a basic level of safety and some evidence of efficacy, to justify a larger scale Phase III trial.

Anyway, the issue gets to the root of major problems in our health care and biomedical research infrastructure: lack of minority investigators, lack of minority health care providers, and failure to involve affected communities at all stages, from setting research goals, to selecting therapeutic targets, to planning trials, to recruiting participants. We need a new paradigm of community based participatory research, to make the enterprise equitable and democratic. But you've probably gotten tired of hearing that sort of thing from me.

Anyhow, now I have to read student papers - and grade them, which I really dislike doing. So hasta mañana.