Public funding of large-scale clinical trials in Australia

To the Editor: I strongly support the editorial comments and recommendations of McNeil et al1 on public funding of clinical trials. Having worked in the Australian healthcare system for 11 years, and having returned to a changed National Health Service in Scotland a few months ago, I can vouch for the benefits that accrue from adequate funding for clinical trials.

While McNeil and colleagues focus on large-scale trials, their comments apply equally to smaller trials. Certainly, in oncology, several trials organisations in Australia have struggled for years to continue conducting trials in spite of inadequate government funding. The ANZ Breast Cancer Trials Group and the Trans Tasman Radiation Oncology Group are but two organisations with which I am familiar. In addition to precarious funding, I believe the consequences in the past 2 years of upheaval in the insurance industry have placed all such groups on an uncertain and untenable footing.

Clinical trials must be ethical, scientific and well managed. Clinicians entering patients into trials need support from essential data managers and clinical nurse specialists. Governments encourage and, in fact, demand evidence-based medicine. The only effective way to produce the evidence is to conduct clinical trials.

That costs money. In Victoria, cancer trial management was supported by about $800 000 per annum in grants from the Cancer Council Victoria. Those funds provided start-up assistance to institutions new to clinical trials and supported the others that could not rely on pharmaceutical company largesse. However, only part of that money was state government funded and then only for rural and regional centres or for breast cancer. The diagnosis-related-group-based casemix funding of Victorian hospitals included a notional element for research. That sop was lost in budget deficits.

In Scotland, where health matters are totally devolved to the Scottish Parliament, the latter’s Scottish Executive Health Department has very recently enhanced funding for cancer care. This includes £500 000 (A$1.25 million) annually to support clinical research in cancer. Each of the three cancer networks has a guaranteed share of that sum to resource clinical trials in all the associated health boards and cancer units.

This is in addition to the excellent clinical trials units in the main cancer centres, often funded by the charity Cancer Research UK and industry. There is also a national system of considering and approving clinical research in cancer. Such approval places obligations on health boards to support such trials. Lastly, accreditation of cancer centres can depend on clinical trial participation.

The evidence that this (still imperfect) system has an effect is seen in trial entry at our oncology centre, where 11% of patients are already entered into trials. The new funding should see that increase.

Government needs to put its money where its mouth is: evidence needs resourcing. The alternative is to rely on charity or on industry (whose eye is more often on marketing than science).