Iain Chalmers and Paul Glasziou think so in this 2016 opinion piece estimating that 85% of research is wasted. That is a vast amount of wasted resources so it is worth looking at the numbers that make up this mountain of waste.
Firstly, only about half of the studies that get done get reported. This is a large source of waste and results from the failure to publish the results of research.
The next source of waste is related to the first in that is estimated that only around half of the research that gets published is sufficiently well reported to be usable and replicable. This means that the report is sufficiently detailed and complete so that another researcher could replicate the experiment.
Of these studies that are sufficiently well reported and published, it is estimated that only around half of these have no serious, avoidable design flaws. This gives the total estimate of 85% of research being wasted.
So, what needs to change? This is where The Lancet’s REWARD campaign comes in and whose aim is to maximise the potential of research by:
- setting the right research priorities;
- using robust research design, conduct and analysis;
- regulation and management are proportionate to risks;
- all information on research methods and findings are accessible;
- reports of research are complete and usable
Let’s now see how this potential can be realised for a randomised trial. Setting the right research priorities for a trial involves ensuring that the study addresses an important and previously unanswered question. This is best ensured by undertaking a systematic review of all of the available evidence. The ATLAS trial is an example of where the need for a large randomised trial came directly out of such a systematic review.
Using robust research design, conduct and analysis for a randomised trial involves focusing efforts on those key principles that really matter when doing a trial. Examples include proper randomisation, recruiting a sufficiently large sample size, blinding and minimising losses to follow-up. This is one area where bad regulation distracts resources from these things that matter and instead focuses on things that matter much less. An example of this is needless data checking. The MoreTrials campaign is addressing the need for better regulation of trials by promoting proportionate regulation related to risks. The recent update to ICH-GCP is an example of improvement.
Making sure all information on research methods and data is accessible is being addressed by the growing trend for online publications of trials to include supplementary annexes of tables and listings of outcomes and data that could not be included in the main publication because of space limitations – the report of the THRIVE trial is a recent example of this. Another development is the implementation of the European Union’s new Clinical Trial Regulation which will include the creation of a new online portal and database where all trials can be prospectively registered and the results can publicly accessed at the end of the study. These changes are the direct result of the AllTrials campaign.
In conclusion, while the figure of 85% of clinical research is wasted is a pessimistic outlook, initiatives such as the REWARD campaign, AllTrials and most recently MoreTrials are responding to maximise the potential of research and, hopefully, will mean that in future less resources are wasted.