Category Archives: Global Clinical Research

2015: Lung Cancer Research Outside the USA

Female Lung Cancer Deaths to Surpass Breast Cancer in Europe

In January 2015, a study by researchers from Switzerland and Italy revealed that lung cancer deaths among women in Europe would overtake those from breast cancer in 2015.[1] Lung cancer is the most common type of cancer, accounting for 13% of all cancer deaths worldwide. That represents a death toll of 1.6 million people, over 80% of who are tobacco users.[2]  While European men have been more afflicted by the disease due to higher smoking rates, the rates among men have been on the decline in the recent past. Meanwhile, the rates among women have been on an upward trend. This year, the prevalence of lung cancer among women in Europe is expected to rise by 9% over 2009 levels to reach 14.24 per 100,000 of population. Meanwhile, the death rate from breast cancer over the same period will fall by 10.2% to 14.22 deaths per 100,000 of population.[3]

The rise is attributed to the delayed effect of the surge in smoking among European women during the period after the 2nd World War and extending to the late 1960s.[4] The UK is one of the main drivers of this trend. Of all the countries surveyed independently, the UK had the highest level of lung cancer deaths, 21 per 100,000 of population.[5] Professor Carlo La Vecchia of the University of Milan, who is also the lead researcher attributed this to the fact that, “…British women started smoking during the second world war, while in most other EU countries women started after 1968.”

Research Shows Personalized Treatments are Underutilized

An international survey conducted between December and January 2015 revealed that the rates of patients receiving personalized treatment for advanced non-small cell lung cancer (NSCLC) remains low despite a large proportion of them (81%) having been tested for EGFR mutations. The results of the study were released in April in Ingelheim Germany, the seat of the Boehringer Ingelheim Pharmaceutical group which is the main sponsor of the study. The results were collected from 562 oncologists from 10 developed countries across Asia, Europe and North America. In Europe, 30% of advanced NSCLC patients were put on first-line treatment before their test results were ready, displaying a huge disparity with Asia (12%). The average global rates were 25%. The main reasons cited by oncologists for non-testing were insufficient tissue, poor patient fitness and protracted process of acquiring results once samples had been taken. Additionally 51% of all oncologists involved in the study stated that their treatment decisions were not dependent on EGFR mutation subtype of their patients. EGFR mutations are present in 40% of East Asian and 10-15% of white NSCLC patients.[6] ESMO clinical practice guidelines[7] recommend the use of EFGR mutation testing results to guide treatment decisions according to each patient’s specific cancer type as this has been shown to improve survival rates at least with the Del 19 mutation[8], the most common type of mutation.[9]

Sources:
[1] http://annonc.oxfordjournals.org/content/early/2015/01/24/annonc.mdv001.full
[2] http://www.cancerresearchuk.org/about-cancer/causes-of-cancer/smoking-and-cancer/smoking-facts-and-evidence#smoking_facts0
[3] http://annonc.oxfordjournals.org/content/early/2015/01/24/annonc.mdv001.full
[4] http://www.theguardian.com/society/2014/oct/07/smoking-falls-lowest-level-uk-recording-started-1940s
[5] http://annonc.oxfordjournals.org/content/early/2015/01/24/annonc.mdv001.full
[6] https://www.boehringer-ingelheim.com/news/news_releases/press_releases/2015/17_april_2015_oncology.html

[7] http://annonc.oxfordjournals.org/content/early/2014/08/11/annonc.mdu199.full.pdf+html
[8] Afatinib versus cisplatin-based chemotherapy for EGFR mutation-positive lung adenocarcinoma (LUX-Lung 3 and LUX-Lung 6): analysis of overall survival data from two randomised, phase 3 trials
    Yang, James Chih-Hsin et al., The Lancet Oncology , Volume 16 , Issue 2 , 141 – 151
[9] http://link.springer.com/article/10.1007/s00330-015-3697-0/fulltext.html

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Advantages and Challenges of Conducting Clinical Research in South Africa

Get To Know The South African Healthcare System

The South African healthcare system consists of public healthcare, which is financed and managed by the South African government, and private healthcare, which is primarily funded by health insurance and private direct fee for service payments. Private healthcare consumes more than 50% of total healthcare spending in South Africa, but only services about 20% of the population able to afford health insurance or direct funding of their healthcare needs.

South Africa Flag RoundThe Attraction of South Africa as Clinical Research Destination

South Africa is classified internationally as a developing country and is often viewed by the less-informed as a poorly developed African country. This is far from the truth.  South Africa has a long history of conducting clinical research; this translates to interest of the medical profession in furthering their knowledge and remaining at the cutting edge of medical development. This is a good indication of the pool of experienced clinical research staff available for research, which is growing and developing as the research environment changes over the years. Clinical research experience is of paramount importance in the South African research environment: it is a regulatory requirement that investigators may only participate as principal investigator after having participated in at least two different clinical trials as a sub-investigator.

A Sophisticated Infrastructure and Clinical Trial Support System

South Africa has a sophisticated infrastructure and clinical trial support system available. Laboratory support to process and analyze blood and tissue samples is readily available in all the large metropolitan cities in South Africa. Most, if not all, of the major laboratories have a clinical trial division that specifically caters for the clinical trial environment, and usually have some partnership/working relationship with the large multinational analytical laboratories. All FREEPIK Medical Imagesthe clinical laboratories are audited and accredited by SANAS. These facilities meet all of the international standard requirements.

Product Depots with Strict Control Mechanisms in Place

As South Africa is located quite a distance from the major manufacturing facilities in the USA, Europe and Asia, investigational product depots are often used to import and distribute clinical trial products to site. These facilities adhere to all international packaging and manufacturing (GMP) and clinical trial requirements (GCP). As they generally receive, store, and distribute clinical trial investigational product for a number of different studies and companies, they have very strict control mechanisms in place to ensure confidentiality and safety of clinical trial product. They are able to manage all types of investigational product at all temperature ranges.

Interested in more in-depth information on this topic? Download our complete article from the May 2014 Journal for Clinical Studies:

CTA Button So Africa

 

 

 

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Immune Manipulation in Cancer Treatment: From Wishful Thinking to Tumors Shrinking

Colin Weekes MD PHD AGICCDr. Colin D. Weekes, Ph.D, PI at UC Denver for The Academic GI Cancer Consultant Consortium (AGICC) of The Oncology Consortia of CRITERIUM, INC. 

The Holy Grail of cancer therapy has been to cause tumors in patients to disappear with minimal adverse effects on normal tissues. It has been clear, in concept, that one way to achieve this end would be to use the specificity implicit in the human immune system to recognize and destroy cancer cells while sparing normal cells.

Over the last 40 years there have been many attempts to stimulate the immune system in cancer patients in the hope that the this nonspecific stimulation would cause the immune system to recognize and destroy cancer cells. The literature is peppered with trials using non-specific immune stimulating adjuvants like BCG (Bacillus Calmette Guerin). Although some studies suggested some traces of antitumor activity, the overall assessment was negative. Dramatic and clinically meaningful responses didn’t occur. Other approaches to stimulate immunity by infusing patients with cells thought to have antitumor activity using auto and allogeneic stem cell transfer were both toxic and clinically disappointing. The adoptive transfer lymphoid cells, which had been “educated” in vitro to recognize and destroy patient’s cancers (IL2/LAK and TIL infusions) tended to be very toxic.  Although significant responses occurred, they were rare and were obtained with toxic side effects that were frequently very severe.

Recently, there have been examples of more significant, more specific and more sophisticated Chemistry behind cancer researchimmune manipulation that may be the leading edge of immune therapies that will be widely applicable to patients with cancer. What may be a “breakthrough strategy” of immune manipulation in cancer has been demonstrated in melanoma. The FDA recently approved the monoclonal antibody Ipilimumab for use in patients with metastatic melanoma. This therapy is unique because its mechanism of action is to increase T-cell antitumor activity by blocking factors suppressing T-cell antitumor activity. Thus the intrinsic antitumor immunity in patients is allowed to function and results in meaningful clinical results (improved survival). Ipilimumab has the capability of producing autoimmunity since it blocks suppression of immune activity.  However, clinical toxicity seems manageable.  Other types of cancer may benefit from Ipilimumab or therapies with a similar mechanism of action.

The second example of a very intriguing immune manipulation in cancer has been reported this week from Rosenberg and colleagues work at the NCI. This group has been studying Adoptive Cell Transfer (ACT) in patients with metastatic cancer for the last 35 years. ACT, although frequently very toxic especially when given with high dose interleukin-2 (IL2), occasionally resulted in tumor regression. Rosenberg’s group now report results in a patient with metastatic bile duct carcinoma who had had very meaningful tumor responses to ACT using a subset of TIL (Tumor Infiltrating Lymphocytes) selected to be cytotoxic to cancer cells carrying a mutation, ERBB2, of an ERBB2 interacting protein. Toxicity of ACT in this setting is manageable and the patient’s performance status after therapy is excellent.

So why be excited about Ipilimumab and the admittedly, very early results of the newest iteration of ACT from the NCI group? First, the use of immunotherapy may be able to circumvent inherent chemotherapy resistance.  Secondly one can imagine that ACT with specific tumorcidal T-cells might combine very nicely with Ipilimumab like agents which enhance T-cell mediated tumor cell death.  Further evaluation of this strategy may warrant further testing.

Maybe, indeed, we are leaving the age of wishful thinking and are closing in on a new age of tumor shrinkage in the immune therapy of cancer.

For more information on the consortia model for drug development in oncology trials, please visit our webpage for AGICC and AMyC.

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A Novel Drug for Treatment of Necrotizing Soft-Tissue Infections

Criterium, Inc., a full-service CRO is proud to be the CRO of record as the supplier of services and support for this important trial.  Further study details are provided by the pharmaceutical development sponsor, AtoxBio Ltd. on ClinicalTrials.gov

Clincial Trial Results ReportA complete article detailing the trial and its current progress was highlighted in JAMA’s April 2014 issue in print and online (http://archsurg.jamanetwork.com/article.aspx?articleid=1859986).  This is a study to evaluate the safety and pharmacokinetics profile of different doses of AB-103 administered to patients diagnosed with Necrotizing Soft Tissue Infections that are scheduled for an urgent surgical intervention as part of their standard of care. The primary study hypothesis is that AB-103 can be administered safely to the patients presenting with Necrotizing Soft Tissue Infections. Secondary endpoints are efficacy by exploratory descriptive analyses of specific efficacy endpoints from three outcome domains to demonstrate treatment benefit of AB-103 in comparison to placebo in patients with Necrotizing Soft Tissue Infections.

The efficacy domains Lab-Beakersare:

  1. Clinical status domain
  2. Pharmacoeconomics domain
  3. Systemic and local inflammatory biomarker domain

Criterium, with extensive experience in dermatology and infectious disease indications, particularly with wound and burn treatments, provided services for data and project management, clinical and medical monitoring, biostatistics, safety, regulatory support, and medical writing.

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Clinical Trials Monthly Case Study Analysis

Each month, we investigate a different Clinical Trial Case Study that posed us with a challenging question – this month it’s a look at INFECTIOUS DISEASE, regulatory issues and patient enrollment:

We asked ourselves: 
Scenario:
A Phase III study required by the World Map Color - NOAM-SOAMFDA for approval was stalled at its North America sites and regulatory processes in South America prevented significant contribution to these studies. There were multiple rejections because this infectious disease study required a placebo control. The study recruitment by another CRO was not met in the previous two seasons.

Criterium offered an experienced team in the Southern Hemisphere to get approval by the regulatory authorities of this placebo-controlled respiratory infection study, to extend the recruitment to 10 months of the year and to enroll at a higher rate per site than the previous seasons’ site enrollment rates.

Criterium’s team averaged more patients per site than the Northern Hemisphere at a high compliance rate for the target micro-organisms.

What If: The client could have continued recruiting patients in the Northern Hemisphere winters, thereby further extending the length of the study.

Results: Criterium managed the regulatory process to receive approval for the study on the first agency reviews and accelerated enrollment with its experienced team in South Africa and New Zealand.

Read more of our successful case studies: http://www.criteriuminc.com/case_studies.php

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How does Criterium RESCUE a study experiencing recruitment obstacles?

Global Clinical TrialsOne of the major requirements for a clinical trial to be successful involves the recruitment of an adequate number of participants so that accurate scientific conclusions can be made. “Adequate” means that an appropriate sample size has been calculated such that even when some drop out of the study, as is commonplace in clinical research, the remaining enrollment will be adequate to allow meaningful evaluation of data. 

A problem arises when a study is in progress, but too many participants leave the program so that the remaining number is too small to provide the required amount of data to provide a statistically significant result. It is our experience that this occurrence often leaves the Sponsor in a position where they begin to seek alternative options in managing the study. 

Analyzing the fall-off to get back on track

As a global CRO we are experienced clinical trials project management specialists. We know how to turn a slow recruiting or high dropout study into one that fulfills the requirements of the statistical analysis plan. We return the study to a viable and productive state using the most cost effective methods. We analyze recruitment and retention plans and identify the problems. 

Once identified, we provide suggestions and an implementation plan for how they can be resolved. Our step-by-step approach includes the following: 

1)  An intense review of the study with the study team. We develop a thorough understanding of all aspects of the clinical trial including the recruitment strategy that was implemented to understand the shortfalls. 

2)  We gather as much information as possible in order to identify what the recruitment and retention problems might be caused by through the conduct of the following types of field interviews.

  • People working at sites that are successful and sites that are struggling
  • Other identified knowledgeable sources that are not actively involved in the study but may provide valuable input,
  • Physicians and community groups who have the potential to provide referrals 

3)  We analyze the data we have collected in order to identify the factors that are responsible for recruitment and retention obstacles. 

4)  We provide you with a detailed report of our findings and the most cost effective solution(s). 

5) We meet with you in person, whenever possible, to review, discuss and brainstorm ensuring that we rank the obstacles from most to least critical. 

In this way, we prioritize the solutions — especially when dealing with budgetary constraints. Clinical Trial RescueBy gaining important feedback, using our own experience and by working together through a team approach, our clinical trials project management team is able to provide you with a complete understanding of the recruitment and retention obstacles faced by your study. 

Our experience and confidence in this approach allows you to take immediate action to get your study back on track towards meaningful and significant results.  

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Global Clinical Research – ISRAEL’s Development Environment

As clinical research is an essential step for pharmaceutical companies, Israel has become a hub for clinical research opportunities, and is becoming known as an excellent arena in which to initiate trials. Israel has made significant theoretical and practical contributions to the biotechnology revolution and has developed an advanced infrastructure of medical and paramedical research as well as bioengineering capabilities. Biotechnology, biomedical, and clinical research account for over half of all scientific publications. The country’s industrial sector has increased its activities in the medical field to capitalize on its extensive knowledge base.  All research resources are provided to local pharmaceutical companies and related institutions.

Israel Pharma Development

Globally competitive with excellent resources and talent

From the Global Competitiveness Report 2012-2013:
Israel is rated 1st in R&D expenditure as % of GDP 1
Israel is rated 1st in quality of scientific research institutions 2
“The country’s main strengths remain its world-class capacity for innovation (3rd), which rests on highly innovative businesses that benefit from the presence of the world’s best research institutions geared toward the needs of the business sector. Israel’s excellent innovation capacity, which is supported by the government’s public procurement policies, is reflected in the country’s high number of patents (4th). Its favorable financial environment, particularly evident in the ease of access to venture capital (3rd), has contributed to making Israel an innovation powerhouse.”

Knowledge and Skill
What sets Israel apart from other potential options? One of the major reasons associated with Israel becoming an excellent research option relates to its knowledgeable workforce. The number of doctors and/or scientists per capita is high within Israel. Global clinical research performed within the nation succeeds because of the proficient talent on hand. These doctors and scientists include some of the finest minds in the world. 6 Israelis in the last 10 years have been awarded Nobel Prizes in the fields of Economics or Chemistry.

One of the fastest growing technology businesses in Israel is life sciences, with over 1,000 companies exporting over $6 billion in pharmaceuticals and medical devices. One well-known Israeli invention is Given Imaging‘s Pillcam, which allows physicians to examine a patient’s gastrointestinal tract with a swallowable camera. The generic pharmaceuticals giant Teva has played an important role in lowering the price of many drugs, as well as bringing to market novel drugs such as Copaxone for multiple sclerosis.

Israel provides an excellent Pharma development environment

Israel provides an excellent Pharma development environment

FDA Recognition
Why is Israel an outstanding option for your pharmaceutical development? It may have something to do with the nation being recognized by the FDA for all related clinical trials and associated research. FDA clinical trials can be launched immediately in Israel. International companies are enthusiastic to join Israel’s rise as a place for global clinical research. World renowned companies are launching ventures to produce high-quality testing facilities within Israeli cities. All research and manufacturing takes place within these facilities.  Interested companies have access to their well-regarded doctors aiming at progress and innovation.

Efficiency Creates Quality
Clinical research is successful when there is an organized, efficient set up to help support it’s functioning. Israel is a cohesive nation that is controlled under one national health program. This enables access to all citizens in the form of their identity cards. All clinical trials launched and established in Israel get off the ground quickly in comparison to other nations around the world. Pharmaceutical, Biotechnology and Medical Device companies are typically approached by Israel to conduct clinical trials within the nation for clinical trials ranging from cardiovascular diseases to neurodegenerative disease. International companies are able to run thorough, professional research trials in an organized manner. This efficiency is important for companies aiming to deliver top-quality results in a short period.

Sources:
OECD Science, Technology and Industry Scoreboard 2011.
Israel’s Ministry of Foreign Affairs (www.mfa.gov.il)
1 International Institute for Management Development (IMD) Global Competitiveness Yearbook 2011.
2 World Economic Forum (WEF) Global Competitiveness Report 2012-2013.

Top photo of Jerusalem by Alex Bruda

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Orphan Drug Development – Why They Are SO Important

Orphan drugs treat diseases so rare that sponsors are often unwilling to follow the usual pharmaceutical drug development marketing conditions. Most rare diseases are genetic, and therefore present throughout the sufferer’s life, even when symptoms are not immediately apparent. Many diseases appear early in life, and a total of 30 percent of children with orphan diseases die before the age of five. Global estimates put the number of different diseases between 5000 and 7000, with an average of five new conditions discovered every week. Unfortunately, in total, only 5 percent of orphan diseases have FDA approved treatment. 

Record Growth Shows Clear Commitment

Although the market is small for orphan drugs, pharmaceutical drug development in this area has seen notable growth in recent years. Currently, 350 orphan drugs are approved for sale in the U.S., including not only pharmaceutical and biological products but also medical devices and dietary products. A record number (10) of new drugs were approved by the FDA in 2011 along with five new drugs by the European Medicines Agency (EMA).

Proven Examples of Success

Orphan Drugs Find a Home

Orphan Drugs Find a Home at Criterium Global CRO

Many large pharmaceutical companies are expanding their orphan drug development and even establishing entire business units dedicated to rare diseases. Although orphan drugs treat only a small number of patients, they can receive a weighty revenue, and companies get a significant competitive advantage by being the first to market. A good example is Rituxan® from Genentech, the second most profitable drug in the world, given orphan status to treat B-cell Non-Hogkin’s lymphoma. In 2010, it yielded $5.24 billion in sales for its use as an orphan drug and for extended usage for other types of cancer and rheumatoid arthritis. It is quite possible to more than compensate for the smaller number of patients an orphan drug may help, through the increased market share, lower marketing costs, higher pricing, longer exclusivity period, and faster returns.

There is an even greater potential for profit when drugs have multiple orphan disease indications or if they can later go on to be used for more widespread non-orphan indications; for example, Gleevec® from Novartis Oncology resulted in sales of $2.4 billion in 2010. In addition, a number orphan drugs are biologics, meaning they are less likely to have generic equivalents, which extends the value to sponsors even after patent expiration.

Economically Feasible – Shorter Development Timelines

Investing in orphan drugs is at least as economically feasible as non-orphan pharmaceutical drug development due to the higher rates of approval and the shorter development times. For instance, the chances of approval for orphan drugs is very high, at 82 percent, compared to non-orphan drugs, at just 35 percent. Additionally, the time taken from Phase II to market is often shorter due to both smaller clinical trials and to the FDA Fast Track designation. On average, the timeline for orphan drugs is 3.9 years while traditional drugs typically take 5.4 years to reach the market.

With new orphan diseases being discovered every week, the potential for pharmaceutical drug development in this area is huge. While initially the market for these drugs may appear small, this is more than counterbalanced by the revenue opportunities and the quick time-to-market.

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The Advantages of Translational Research Methodology

Applying basic research knowledge to practical applications is a well-known obstacle to progress in science. This issue is seen most often in medical science. There is often a lag between emerging scientific findings and their application as treatments to patients who may benefit from them.Translational research is aimed at taking basic science  research to the next level. It connects new discoveries to application in patients.

Multidisciplinary Collaboration
There are four basic steps to consider in this research tactic.

  • Development of techniques to translate new knowledge generated in a lab environment, or at the bench level, to human testing
  • Refinement of human study results for  clinical use
  • Transference of practices from academic medical centers to use in the care of patients in community practice
  • Continued evaluation of data from the previous steps to provide confirmation of the efficacy and tolerability of new therapies

The goal of translational research is to quicken the transition from the lab to the patients who may benefit from the basic science findings. Thus translational research is a collaborative effort among basic researchers, academic physicians and community health professionals to provide new treatments to appropriate patient populations.

Funding Options
Translational research can potentially expand the funding options for a project.

  • Researchers benefit by working with a center that is able to provide seed funding. They reduce overall project costs by utilizing basic science center personnel for development of new therapies that then can be applied to patients in the community..
  • For universities, setting up a translational research center is a tactical approach to improving funding options. Through the research center, academic organizations develop strategic plans to provide improvements in public health benefitting overall community.
  • Communities benefit by gaining a stake in the study. The community becomes a contributing member of innovative medical research.

Stoking Excitement in a Field of Study
The developing barriers between research and clinical applications tend to dim interest in research projects. Moving towards a translational approach expands these possibilities. The power to take new knowledge from the bench to a clinic setting and then back to the bench for analysis lifts some of the impediments to expanding interest in a project.

Translational Science Research

Physicians in the community are able to see
basic research translated into practical application. A project that was once unapproachable due to time constraints and the complexity of the study boundaries will now draw interest and participation.

Translational research is a bench-to-bedside approach to medical developments. With this two-fold methodology, basic science presents tools to clinicians that have the potential to improve patient care. Clinicians are able to make observations and provide valuable feedback about the progression of disease that will lead to more discoveries. A translational model benefits the community by speeding the application of new research findings to patients and thus drives the clinical research progress at a quicker pace.

The Oncology Consortia of Criterium believes this methodology is the best way to speed results of research to benefit the public – it’s why we say we are “Changing the Way Cancer is Managed”.  Read more about our approach at the Academic GI Cancer Consortium or at the Academic Myeloma Consortia web pages.

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Claire WyntersThu, 11 Apr 2013 15:07:00 GMT

Why run global clinical trials?

Clinical trials are a vital aspect of the pharmaceutical industry – both as a source of validation for previously untested methods, as well as a way to publicly demonstrate the effectiveness of a developing product. As humans across the planet collaborate and network, global clinical trials are a necessity for maintaining accurate data across numerous demographics. Furthermore, conducting trials abroad positively influences the economies and well-being of developing nations.

Globe made of Flags_200All around the world, various ailments and negative conditions affect local populations in differing ways. To best treat the plethora of issues present in these wide-ranging communities, global clinical trials are needed to address the growing variable factors involved. It is a recognized fact that minority groups and third-world citizens are vastly underrepresented in the modern medicine developed primarily by Westerners. This is changing rapidly, as more and more clinical trials are funded and performed globally.

An important aspect of conducting global clinical trials is being aware of the differing regulations that exist in developed countries vs. under-developed countries. Every trial has its own unique ethics and complexities that are carefully monitored and assessed by licensed physicians, and not shoe-horned into a universal set of regulations that may be inappropriate for any specific trial. By hosting testing locations in many under-developed parts of the globe, a more local flexibility can be used in research efforts for effective medicines in indigenous populations.

Additionally, conducting global clinical trials allows for researchers in smaller countries to work at the forefront of their field. While experts often travel to oversee the process, global trial activity means more employment and experience for the local doctors, investigators and clinical personnel. This provides ample opportunity for externally sponsored clinics to receive additional funding and investment which, in turn, can lead to a healthier and happier population overall.

Working in developing nations offers an opportunity to expand the scope of any trial – both seasonally and with groups of people Caduceus_311who have not been exposed to new medicines in a variety of therapeutic areas. Because of these naïve patient populations, more extensive clinical trials can be executed and analyzed. Pharmaceutical corporations concerned about their bottom line have to carefully consider the best allocation of their funds — and it’s important to understand that running trials in developing nations does not always provide a cost savings. Money must still be spent on securing locations, basic products, and housing and care of employees, and budgeting must suit the needs of the specific trial in that specific global location.

Medicine is a particularly important and valuable branch of practical science.  Seeking new, reliable and innovative information can be a timely, costly, and difficult process — and global clinical trials are much needed to improve the health problems of the world at large. Global trials provide more in-depth data across a wider demographic possibility, better freedom to experiment and explore, and more importantly, vital support of local native economies.

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Claire WyntersWed, 30 Jan 2013 14:45:00 GMT