Stanford Medicine explores the complex world of clinical trials

Back just 100 years ago, the notion of testing treatments and drugs through randomized clinical trials was unheard of. Clinical trials began to proliferate only in 1800, placebos were first used in 1863 and randomization wasn't introduced until 1923.

But nowadays, clinical trials are the bedrock of medicine - and the stuff of front-page news, with stories trumpeting new findings, while others point to inadequacies and even corruption in clinical trials.

So the summer issue of Stanford Medicine magazine explores clinical trials in a special report, "Trials on trial: Clinical studies under the microscope."

The report's lead story describes the growing complexity of trials, and the repercussions. One result is a slowdown in the development of new drugs, a consequence that Philip Lavori, PhD, professor of health research and policy sums up like this: "It's not just that the pipeline hasn't produced a gusher, but that it's falling to a trickle. We can't continue on the road we're traveling. It's scary - the system is heading toward some sort of cusp."

Other articles include:

• An essay by Abraham Verghese, MD, observing that strong clinical trials evidence can persuade, but a good story is often even more powerful.
• A conversation with newscaster Katie Couric on what's behind her push to raise funds for cancer research.
• A feature on the hope clinical trials offer to those with incurable disease, focusing on a man with ALS. A video brings viewers into his home.
• A look at the growing numbers of healthy people participating in clinical trials - or "guinea pigging" - for a living.
• Perspectives from four Stanford faculty on what's wrong with clinical trials and what to do about the problems.
• A story on how clinical trials provide knowledge and support for women at risk of breast cancer who take part.
• An article about placebos, explaining why nothing really is something, and in some ways is better than anything. In a video interview, Sean Mackey, MD, PhD, shows what happens to a brain under the influence of the placebo effect.

Also of note:

• A feature on a treatment dreamed up in the laboratory of Amato Giaccia, PhD, that might stop cancer from spreading.
• A "flashback" to a century ago, when Stanford's medical school was founded and homeopaths and allopaths vied for dominance.