The ethics of placebo-controlled trials

Challenges and opportunities: what we are learning from the clinical natalizumab experience

The approval of natalizumab for relapsing forms of multiple sclerosis, and the subsequent voluntary suspension of its use due to an unexpected viral infection, is a cautionary tale of how much we have to learn about how to prioritize and perform the necessary research and development of novel therapeutics for human diseases, the ethics of placebo-controlled trials and the relationships between researchers, regulatory authorities and the pharmaceutical industry.

How to do clinical research in cranio-maxillo-facial surgery

INTRODUCTION

Not many randomised controlled trials are published in surgical journals, especially those on maxillo-facial surgery. There appears to be some uncertainty on how to perform such studies. Accordingly this paper offers some information on how to plan, pursue and publish a well conducted case-control study, or the more powerful randomised control trial.

RESULT

The main section describes how to define a relevant clinical question, and a research protocol, the way to implement the study, and it helps to find funding for such research. It also explains the various study designs, gives a very short introduction to statistics and on how to appraise the results achieved, and it advises on writing and submitting the resultant manuscript.

CONCLUSION

This paper offers a guide for young colleagues who wish to perform a study, write a paper and achieve publication in one of our leading speciality journals.

Ethical and Scientific Perspectives of Placebo-controlled Trials in Schizophrenia

Clinical trials for development of new medications are essential in all fields of medicine. The requirement for a placebo arm in pharmaceutical trials presents ethical and clinical dilemmas that are especially complicated with regard to mentally ill persons whose free choice and ability to provide informed consent may be questionable. On the other hand, we do not believe that this predicament justifies unconditional rejection of placebo use in psychiatry, when the investigational drug may ultimately provide substantial benefit for some patients. At the same time it is the psychiatrist's responsibility to insure that investigators are adequately trained to conduct clinical trials and that stringent regulatory committees supervise the scientific, clinical and ethical aspects of the trials.

KEYWORDS

Placebo-control; Schizophrenia; Medical ethics; Clinical trials.