Purely Lithuanian answer: why do we need to know? That's right. There are so few Covid-19 patients in Lithuania that no serious research on Covid-19 drugs is possible. But we need to know how the best clinical trials are done. We have many cases of cardiovascular disease and cancer. It is high time we worked seriously on this in Lithuania.
The most important answer to this article's question is that, thanks to the stupidity and wandering of the British Prime Minister, the clown, Johnson, the British have many Covid-19 patients and those who have died from the disease. Do as much research as you want. But that’s not the whole story.
"Maybe the most important factor is an attitudinal difference: British clinical researchers have a longstanding commitment to large, simple and rapid randomized trials. American researchers prefer smaller, selective and complex trials with many restrictions on patients who can enroll.
Martin Landray, who is leading Britain’s effort, known as Recovery, identified six other factors that contributed to its success in an interview with us. They should be applied in the United States to produce more rapid, large-scale clinical trials of Covid-19 therapeutics.
First, the protocol for the Recovery trials was designed to be highly accessible, and the paperwork was short and easy for all health care providers — doctors, nurses, even medical students — to follow.
Second, the Recovery protocol was quickly approved at the national level and adopted by all hospitals in Britain.
Third, background patient data provided by Britain’s National Health Service helped to simplify the research process. Information like age, race and comorbidities are already built into the hospital systems for all patients, so providers didn’t have to collect that information. Follow-up data is more comprehensive because post-discharge mortality can be tracked through the N.H.S. database.
Fourth, support from top leaders in government health care ensured widespread uptake by hospitals. The four chief medical officers of England, Scotland, Wales and Northern Ireland each wrote to every hospital executive in their country that participating in the Recovery trial was a priority.
Fifth, Britain has a national system of research nurses who were rapidly redeployed to work on Covid-19 research at the beginning of the pandemic.
And last, the British effort was incorporated as part of everyday clinical care in hospitals. The alternative, of just trying anything and everything in a haphazard manner, which seems to have been the American way, was rejected in Britain because it neither optimizes patient care nor generates useful data. The philosophy that clinical research is the standard of care — a philosophy common in cancer care — was the right and ethical approach for Covid-19
An additional feature worth noting about the Recovery trial is that it has been relatively inexpensive to conduct. Oxford’s grant for the study was roughly $2.1 million. N.H.S. clinicians recruited patients as part of their job and drugs were provided as part of the N.H.S. Even with the additional cost of paying for clinical research associates, the trial was remarkably inexpensive and has proved its value. "
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