Clinical Trials

Well, I would say look at it seriously, and see if you can possibly take part. Obviously some are a little bit more daunting than others. I feel the one I took part in, it didn’t really involve a tremendous risk, say, and perhaps others may be little bit more risky, but I would say look at it seriously and see if you’re able. And if you’re able do take part because it all, every little helps, to improve treatments.

A trial is a very personal thing, I think. Some people would be quite positive like me, and would think, “Yeah, it’s going to be good for me, it’s going to be good for others.” Other people might be a bit dubious whether to go into that sort of thing. But I think if you sit back and think about it, that medicine has made such a progress over the years, and it’s only because the likes of people doing clinical trials, drug trials. You’ve got to practice on somebody, you’ve got to find these results from somebody, and the only way they can do it is to do these trials, so it can only be for the good of yourself and for other people.

 

I would say yes. Because, because of that they get to know how not to or a way how to treat certain conditions, certain sicknesses, certain disease, yeah.

 

 

Not wholly [laughs]. I think partially. I think it worked partially, not wholly.

 

 

Yeah, totally, uh-huh. I wished that would happen.

 

 

Yes, I am, yes. Mm.

 

My experience, from my experience, I would say, well, if, if you’re asked to take a trial for whatever purpose, I would say, “Go ahead and do it, yeah.” It can only, good can only come of it, in my estimation, yeah. And that is you’re helping yourself and help other people who might come after you.

 

 

Not really. No, my decision was personal, really. But I know that what is good for me is good for the goose or the gander as well. So [laughs], so from my point of view if I, if I could , there’s somebody else who might need the same type of treatment to make them good. So it’s all right.

Well, as I say, if you’re asked to or if you’re approached to be going on one of these trials, obviously think about it, you know, think what it involves. But I would be, I’d tend to encourage them to do it, you know, go in for it. You can always pull out. You don’t, you’re not stuck there for a year or two years or whatever. You can always, if things are not going right, you can always pull out.

 

But I would encourage anybody to go ahead with it, unless they’ve got any real fears about it. You know, I think you’re in good hands and, as I say, you’re being monitored, you’re being checked all the time. It’s specific to the problem you’ve got, so you’d be getting more individual, you know, more specialist treatment. And it tends to be more relaxed in going to a hospital than to your doctor’s, you know. So I’d, I’d encourage anybody to, to do it, try it. And if, if there are any problems, let them know straight away, you know. You have to, you know, if anything does go wrong, obviously you’ve got to speak up and tell them you’re not happy. But I would encourage anybody to, to go ahead. 

 

Give it serious consideration, get as much information from your consultant, oncologist, whoever’s talking to you about it, talk to your family about it also. And again, as I said earlier, I think a lot will depend on the individual’s prognosis and how you view the best possible treatment that you can get. The treatment won’t be any worse, because if, as I said earlier, if you feel as a person that’s it not doing you any good or if it’s making, your quality of life is being reduced by it, speak to the doctor, speak to your consultant. If they see also that it’s having serious effects and negative effects, they’ll pull you out of it. So you always have the option of stepping back from it. But do give it serious consideration, because you will be treated well. There is the aspect also that a lot of people say, “Well, if you’re in a clinical trial you get better treatment.” I don’t know if it’s a case of getting better treatment. I think probably there are more tests done on you to make sure that the drug is not having a negative effect, so in that way perhaps people think they’re getting better treated. But I was involved in doing, as a part of the working group with the NHS Quality Improvement Scotland, doing the standards, reviewing the standards for lung cancer, and also for the core cancer standards, and that was one of the things that I got them to put in it was that just because you take part in a clinical trial doesn’t mean that, if you don’t take part in a clinical trial doesn’t mean you’re not getting the best of medical attention. So you are. But no, I would seriously give it serious consideration for taking part in a clinical trial, yes.

I think anyone being asked to take part in a trial should ask some quite penetrating questions. I mean, I think first of all they should approach it in a positive state of mind that on the whole we patients would like to help science wherever at all possible. Doctors are trying to provide better proof, better evidence, better treatments, and I think it’s the least the patient can do is to help as much as they possibly can. But in the end you have to look at the particular trial very, very carefully. And I think really you need, it’s a good idea to get a second opinion from somewhere else, if it’s on something that’s very important. I mean, if it’s something minor, obviously not. But if it’s something, you know, possibly life-threatening that you suffer from, then I think you really need to know all there is to know about the treatments that you’re being offered, or possibly denied, if you’re going to be randomly put into a group that’s going to get a, what might be a very good treatment or into a treatment that perhaps might do you some damage. You need to know what those risks are and decide whether you’ll take them or not. Of course some trials, you’re not going to be offered the treatment unless you’re on the trial. I think that’s a very, very difficult call and I think that puts a lot of pressure on, on patients who perhaps very much want the treatment, can’t get it any other way, but might be randomly assigned to a group that don’t get it.

 

And I think that’s a deep ethical dilemma. Of course if it is a very, very new treatment and the scientists genuinely don’t know if it’s going to work or not, I don’t see how else they can proceed except on that basis. So I wouldn’t rule it out and say, “That’s unethical, that’s unfair”, because I can’t quite see any other way of, of resolving it. You can’t give everybody every drug that might have some effect indefinitely. It could be dangerous as well as expensive. 

And anybody who’s thinking of going on a trial, ask questions. If you’re uncertain in your own mind that, “No, I don’t think I want to do this” or, “This isn’t for me”, then say so, because it at the end of the day it’s your life. It’s entirely up to you. And if you don’t think it’s right and if it’s not right for the family, then don’t do it. If it’s going to make you unhappy, don’t do it. If it’s going to really worry you that, “This is a trial and I don’t know the results”, then I would say, don’t do it. 

I think if people were, had been invited to partake in a trial and were just thinking, “Well, is it right for me?” I would say, “Just ask as many questions as you can. Ask the clinician, whoever’s sitting in front of you just to talk through what the real chances are, the real options are. Have a look at all the patient information leaflets that come with it. And maybe speak to other people who are on the trial” - although I suppose that might be difficult because of confidentiality. I suppose I can only speak for myself now. But if I had something wrong with me, I would be far more likely to enter a trial now than I would six years ago when I didn’t know about it. But I can’t expect everybody else to go on a six-year learning circle. So all I could say would be, “Find out as much about it as possible. Read everything. And then just take time and think, ‘Is it right for you?’”

 

In terms of the professionals, my advice to them would be, “As far as always possible just put yourself in the other person’s shoes.” I still, I’m a great fan of hierarchy. I look up to people. That’s my age and that’s the way I was brought up. So quite honestly if a clinician said to me, “Lester, I think this is worth trying”, I would. Now, I’d have to make sure I wasn’t doing that just to please him. But I think I’d ask questions. But I think I’m more likely than not to go in a trial. If it was a screening trial, a big data collection trial, I would say absolutely, go into it. And you’d almost have to have strong reasons, very strong, good reasons not to. Because if it’s not hurting you, but it’s helping others collect information, I don’t work on the principle that they’ll then misuse it, I don’t worry if somebody loses my CD-ROM with the data on, I really don’t mind at all. You know, that’s life. We all make mistakes, we all have errors. Just get on with it, really. So I would think in terms of screening, in terms of big sort of social service type trials, just do it, absolutely. And yeah, my advice to professionals would be, “Just put yourself in the other person’s shoes.”

 

We just have to advance by comparing in a very rigorous way how we go forward with treating patients, otherwise we’re going to be stuck in not knowing. So yes, I thought trials were a wonderful idea, but it did occur to me that if I’d been on the trial working party, I would have some things to say about the information sheet. I would have had things to say about the end points. I would have had things to say about the possible outcomes, and about the feasibility of this trial. Because a huge amount of money was spent on it. It was a very costly trial, because of all the contention, I suppose. So there are economic aspects that need taking account of. Yes, I’m totally for clinical trials but they must be good quality clinical trials.

 

And, as I found with the people that I have spoken with and worked with, and indeed the clinicians more locally, I think it can only come about by a partnership between patients and health professionals, because we each have something different to give to, to devising any project, concept, trial that needs to be done. And the prior-, prioritisation of topics as well. You know, what is important to patients? What do they, what would really make a difference to their care? What do they want to know? Because they’re at the sharp end. They know what they want to know. They know what research would benefit.

 

And I think those patients that have become involved in this are able to stand back. They don’t do it - they do it based on their own experience because they know what it feels like - but they do it in a sort of detached manner. They have to become professional in their own way, in order to realise that this is an activity that’s undertaken on behalf of future patients. You do it on the basis of what you’ve learned today, what you’re learning today, but you’ve got to go forward and I think to do it in partnership is really the only way to do it. So yes, I’m totally for it. But the trial has to be well designed, well balanced, and presented in such way as to make sense to those who are going to participate. Otherwise it’s pretty futile if they don’t understand what’s happening.

 

 

Hmm. It’s easier to describe a bad one, isn’t it? And this is why I got involved, because I was invited to participate in one that was not balanced. The first thing that springs to mind is of course that it should be, let’s call it a legitimate comparison. It has to be utterly legitimate. In other words it has to be a comparison with, that is based on first of all the best standard treatment, a thorough overview of what is known on that topic - you can’t just have a bright idea and plunge in and ask for money. You have got to do your homework and find out what is known about this particular topic, before you even go, go there. I think I suppose the next requirement is to sort out, prioritise the question itself. In other words, how are you going to frame the question? It has to, I think, accommodate what are the important things about the thing you’re researching.

 

So framing the question that means something to both the clinician - in other words the sort of scientific, clinical treatment aspects - together with the aspects that the patient wants to find out. It’s, I think, no good having a trial that’s got an outcome that is meaningless. How are you going to get people to participate if they can’t identify with the purpose of the whole comparison? So it has to be a fair comparison.

Well, for people taking part in trials, I think you do need to find someone who has the time to explain to you what it’s about. And you need to think about whether or not it’s going to, broadly speaking, be more valuable to the bigger, wider world than it is to you, or whether you’re doing it to help yourself, because the level of impact of side effects and, you know, what it actually does for you makes a bit of a difference. But I think in that you do have to find someone who’s willing to talk to you. And probably take it away from the arena if you have time, the actual research arena. And I don’t know whether a GP is any help, but I’d like to think that a GP could be revved up to take the sort of practical interest. I have to say my own, who is a wonderful guy, he backs off when it’s a question of talking about research.

 

And I don’t know who else you can go to, other than possibly people like yourselves at DIPEx* [hexi.ox.ac.uk], and say, “Well, are there other consumers out there who I could talk to?” Because it would be quite nice to feel that you could get access to people with a bit of experience who can help you understand it. I mean, there are quite a lot of groups that you can track through the website and so on. I’ve not used them, so I don’t actually know whether or not they’d be helpful. But I certainly think that if you have time, talking about what it means and why it might be valuable is probably helpful, set in the context of how it’s going to impact on your life. I think it’s different if you’re ill than if you’re a carer. It really just is. And it’s obviously different if you’re ill and you’re hoping for a saviour to come along, because I think mostly I doubt whether trials actually do that for you. There are not very many which save your life. But that doesn’t necessarily mean they’re all awful or that they are bad things to be involved in.

 

*DIPEx is the name of the charity which runs this website.