The several faces of clinical trials: from new therapies to failed preventive strategies

摘要

Over the past few years, editorials in various pre-eminent journals have celebrated cardiovascular drug and device therapies and interventions that have proven efficacious in double-blind, randomized, controlled trials. In wealthy countries, over the last three decades such research has led to the average lifespan being prolonged by about 6 years. Advances in cardiovascular medicine should be acknowledged, but significant areas of concern remain, such as the following: conflicts of interest and bias (e.g. financial or academic bias, or selective reporting by editors of positive trials); growing private funding for pharmaceutical and interventional research resulting in increasing financial opportunities for physicians and investigators (e.g. fees for advice that dwarf consulting payments); and unclear consent information. Furthermore, and perhaps most importantly, even with the enormous advances in treatments, prevention of cardiovascular disease is dramatically failing, and trials to address prevention are proving difficult.