February 6, 2010

UK: The trials of age

. LONDON, England / Financial Times / Weekend Columnists / February 6, 2010 The trials of age By Margaret McCartney Old age is often beset by a variety of illnesses and health risks, and we end up taking a large number of pills as a result. But even though the elderly are more likely to need multiple medications, we still do not know enough about the effect these medicines have, since older people are rarely included in trials. As Professor Peter Crome, former president of the British Geriatrics Society, says: “They [the elderly] are less likely than younger people to have clinical trial evidence on which to make decisions about the risk and benefits of drugs and other treatments.” This, he believes, is a form of age discrimination. One study showed that even though almost 40 per cent of heart attack patients are over 75, only 9 per cent of people taking part in treatment trials for heart attack were in this age group. A new project is trying to correct this distortion. The scheme, PredictEU, is examining the reasons why older people are under-represented in trials across Europe. Using this information, it’s organisers have drawn up a charter for the rights of old people in clinical trials. THE RIGHTS OF OLDER PEOPLE IN CLINICAL TRIALS Many people on ethics committees believe that performing trials on the frail or elderly is risky. How can vulnerable patients properly consent to a trial, they ask. This concern is justified, but the fact remains that many of these groups have been left with untested treatments, and without decent improvements in therapies. For example, people over 80 are not often studied, even for common conditions such as high blood pressure. So research findings for younger people are extrapolated to older people, even though age changes much of our physiology. A recent editorial in the journal Clinical Evidence highlights the difficulty of managing high blood pressure in the over-80s when, until recently, there was insufficient information from clinical trials. It has now become clearer that blood pressure treatment can cut the number of strokes in this age group (with one stroke avoided per 25 people treated over five years) without reducing mortality. This means that the treatment may be causing deaths in other ways, such as making falls or hip fractures more likely by lowering blood pressure. Not testing medicines in this group of people may have been doing definite harm. The charter that PredictEU has delivered aims to ensure that older people are fully represented in clinical tests. While doctors are coming round to the idea of fair tests for all, patients now need to realise the quiet scandal of research that has wrongly claimed to help to them. [rc] Margaret McCartney is a GP in Glasgow. E-Mail: margaret.mccartney@ft.com Copyright The Financial Times Limited 2010.