Tax-funded clinical trials improve the quality of health care

When a patient walks in to an excellent medical practice, she has reason to expect several things: a courteous and professional atmosphere, answers to her questions, explanations as to what her provider thinks the problems might be, the choices as far as therapy, and what her provider recommends to be done. The principles are timeless, but thankfully the therapies are not. They improve over time.

Most of these changes come about as a result of clinical trials. And, there are two broad families of trials: one family is drug company-sponsored, and the other family is made up of those trials that are ultimately funded by our tax dollars. Only the first family was reported on by the Mail Tribune this week.

Here, I'd like to talk about the other group — the university-based, collaborative, peer-reviewed questions we need answered to find better treatment for our most awful diseases.

When I became an oncologist 20 years ago, there were two treatment choices for people diagnosed with the common bone marrow cancer called multiple myeloma. When one didn't work, the oncologist tried the other, and when that stopped working, most patients had no realistic treatment options left.

This morning I looked up today's myeloma treatment guidelines. They list 10 different potential regimens for initial therapy, using five new (and six old) drugs in varying combinations. With this, average survival for a myeloma patient has at least tripled over the past two decades. I've watched my patients' quality of life go up, and their painful complications of the disease go down: I no longer get calls from the emergency room that a myeloma patient has broken his arm while raking the leaves.

How do we know what to do? When a new drug is approved for a type of cancer, should it be used first, or later? Should it be combined with older drugs, or does that just add side effects? Do only some patients benefit, and if so, which ones? Can the new drug finally replace an older, more toxic drug?

The only way to answer this is to collaborate. As a profession, we ask hundreds — sometimes thousands — of patients to consider enrolling on national trials, asking if A plus B is better than B alone; to carefully monitor the toxicities and the results; and to report our results — good or bad — in a forum where all can see, question and criticize.

Even the Mayo Clinic can't be expected to enroll a thousand patients with the same disease in any reasonable time, so universities collaborate. And, with commitment, local communities may join those universities and thereby offer their patients locally many of the same trials they would be offered at Mayo or Stanford.

Twelve years ago, in a collaborative, humanitarian effort between Rogue Valley Medical Center and Providence Medford Medical Center, we became an affiliate site with Oregon Health and Sciences University. An independent local Institutional Review Board, chaired by Dr. Mike Narus and largely staffed by volunteers, is charged with asking the hard questions of the investigators before any trial is opened in the Rogue Valley.

In that period, almost 40 nationwide, peer-reviewed, National Cancer Institute-endorsed collaborative cancer trials have opened in the Rogue Valley. Sixteen are open today.

Does the program make money? The last time I looked, financially the program was a net loss.

Is it the right thing to do? Ask any breast, lung, colon or prostate cancer patient. They all can expect to live longer and feel better than they could have expected 20 years ago.

The last time I looked, that was the reason I went into medicine in the first place.

Dr. Charles R Dibb is president of Hematology Oncology Associates, an NCI clinical investigator, and a clinical assistant professor of medicine at OHSU. He has practiced in the Rogue Valley since 1992.

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