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Recently the results of two large clinical trials in Parkinson’s were announced. Both indicated that the therapies involved had not demonstrated any impact on the progression of Parkinson’s. This disappointing news resulted in the usual headlines (“Epic failure” & “Clinical trial tanks”) from news outlets whose editors have obviously never lost anyone they cared about.
In addition, there has also been a useful chorus of “I told you so” and “We’re going the wrong way” coming from the back seat of the car, despite the fact that we haven’t seen any actual trial data yet, or the fact that they can’t propose any viable alternative approaches.
What is missing in all of this noise, however, is a better approach to failure. Not only an open and honest postmortem of what worked and didn’t work in the studies, but also better, more respectful ways of communicating results.
In today’s post, we will discuss our approach to failure.
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PART 1. POSTMORTEM
The book I gift the most is Sherwin Nuland’s “How we die”.
As a rule, I am selective as to who I gift this to, never for Christmas or birthdays, and I always remind the receiver of the gift that “you should not judge a book by its cover”.
This book is so precious.
A poetic set of reflections from a medical doctor who has sent his entire career watching ‘life’s final chapter’. There is science, wisdom and beauty on every single page. Nuland has such a wonderful way with words, and I find myself constantly going back to this book and finding something new.
Sherwin Nuland (1930 – 2014). Source: Theparisreview
My favourite part of the entire book is chapter 11.
Throughout the first half of the book, Nuland pushes the argument for returning some dignity to our last days of life. Rather than prolonging suffering in a futile effort to extend life a few short months, he implores the reader to let nature simply take its course.
But all of this changes in chapter 11, where he describes the moment his brother Harvey called him on the phone and told him he had been diagnosed with terminal cancer.
In an instant everything changed. The context had shifted, and instead of “let nature simply take its course”, Nuland recalls how his thinking immediately became “we have to do whatever it takes to keep my brother alive”. (And I’m not ruining the book by sharing this spoiler – there is so much more in this book. It should be required reading for first year medical students).
Matthew Syed. Source: Amazon
It investigates how we approach failure, and the first chapter describes everything that is wrong with how we currently conduct clinical trials.
What does it say?