Bioethics Blogs

How do researchers decide early clinical trials?

Launch of clinical investigation represents a substantial escalation in commitment to a particular clinical translation trajectory; it also exposes human subjects to poorly understood interventions. Despite these high stakes, there is little to guide decision-makers on the scientific and ethical evaluation of early phase trials.

In our recent article published in Medicine, Health Care and Philosophy, we review policies and consensus statements on human protections, drug regulation, and research design surrounding trial launch- concentrating on evidentiary factors used to justify launch of clinical development and to evaluate risk and benefit for subjects. We conclude that existing policies grants very wide moral and scientific discretion to research teams and sponsors. We then review what is currently understood about how research teams exercise this discretion, and find that decision-making surrounding trial launch is not simply- or even primarily- centered on proof of principle or concerns about subject welfare. It involves a constellation of commercial, regulatory, and professional considerations. Investigators are adept at establishing and maintaining their authority over decisions surrounding trial launch, and they emphasize that preclinical research is an important resource in legitimizing trial launch and enrolling other actors. However, nothing in this last point suggests that preclinical studies are mere rhetorical devices. If preclinical research is a key resource in enrolling other actors, it is surely because it contains content that resolve certain uncertainties.

We close by laying out a research agenda for characterizing the way investigators, sponsors, and reviewers approach decision-making in early phase research. We suggest that by investigating how various stakeholders describe, reason about, approach and resolve questions about ethics and study validity guidance can be established on a design and review principles for trial launch.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.