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At least in the US, the article discusses a valid but frustratingly incomplete step per-nation. There's a broken incentive system for doctors: they are in small/regional academic centers and get rewarded for recruiting, but mostly when there are few other participating doctors (and thus limiting # hospitals & included communities). You don't get the pharma relationship/funding, no academic recognition for being one middle author over many, no time for understanding all the trials, etc. For blockbuster trials like COVID, the care ROI potential is obvious, but few are like that. Stuff like cancer is a pathologically bad case bc you often do need that wider net, even when going for an ultimately small patient group. You don't know which hospitals people with the markers being targeted will show up at, nor if they'll fill your diversity goals (... which pharma doesn't actually want as part of the negotiated trial setup, another story). But even if a national register identifies a regional patient + their care provider, chances are, that's not enough for the doctor to enroll the patient. National registers, or at least more smoothly federated ones, are a good step to decreasing some of the patient identification cost. For cancer, with growing regional genome databases, especially so. But there are several big carrots + sticks doctors face when choosing which trials the system wants them to pursue, and the COVID stuff was able to skip much of that. Source: daily dinner conv with someone doing the treatment/prescribing, trial enrollment, and working on one of the US's biggest national registers, including to use data to solve targeted trials, yet still struggling. |