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Unpublished trials ‘violates ethical obligation’ to patients

Published on 30/10/13 at 08:16am

A new study published in the BMJ has found almost one in three (29%) of large clinical trials remain unpublished five years after completion.

And of these well over two-thirds (78%) have no results publicly available, according to the research by US-based authors.

They say this means an estimated 250,000 people have been exposed to the risks of trial participation without the societal benefits that accompany the dissemination of their results.

They argue this: “Violates an ethical obligation that investigators have towards study participants,” and call for additional safeguards “to ensure timely public dissemination of trial data”.

They note that these types of studies depend on the willingness of people to expose themselves to risks, but the ethical justification for these risks is that society will eventually benefit from the knowledge gained from the trial.

But when trial data remain unpublished, the societal benefit that may have motivated someone to enrol in a study remains unrealised.

US law requires that many trials involving human participants be registered - and their results posted - on the largest clinical trial website But new evidence suggests that this legislation has been largely ignored, according to the BMJ piece.

New regulations coming into Europe next year will ensure greater trial transparency on the continent, but no such laws are forthcoming in the US. The UK-based AllTrials campaign which the BMJ supports, is also calling for great global transparency, but pharma is still fighting the need to disclose all of its data. 

An ‘important problem’

The US-based researchers set out to estimate the frequency of non-publication of trial results and, among unpublished studies, the frequency with which results are unavailable in the database.

They searched scientific literature databases and identified 585 trials with at least 500 participants that were registered with and completed prior to January 2009.

The average time between study completion and the final literature search (November 2012) was 60 months for unpublished trials.

Registry entries for unpublished trials were then reviewed to determine whether results for these studies were available in the results database.

Of 585 registered trials, 171 (29%) remained unpublished. Of these, 133 (78%) had no results available in Non-publication was more common among trials that received industry funding (32%) than those that did not (18 per cent).

“Our results add to existing work by showing that non-publication is an important problem even among large randomised trials,” say the authors. Furthermore, the sponsors and investigators of these unpublished trials infrequently use the results database.

The lack of availability of results from these trials “contributes to publication bias and also constitutes a failure to honour the ethical contract that is the basis for exposing study participants to the risks inherent in trial participation,” they add.

“Additional safeguards are needed to ensure timely public dissemination of trial data.”

Ben Adams

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