Coauthors

An interesting idea from our head of Department - all of my coauthors in a word cloud:

Clinical trials recruitment

Recruitment into clinical trials is an extremely problematic question with regards to ethics. Generally, participation in a clinical trial is a (minor) risk for the individual, but an enormous (potential) gain to society. In the past, this dilemma was "solved" by force - running clinical trials on prisoners, the mentally disabled, the poor, residents of third world countries and generally any population that was disenfranchised. This unethical behaviour is now widely condemned and has been illegal now for a long time.

So how then are patients recruited for clinical trials? Essentially the safeguard for ethics is the principle of volunteering with informed consent. In certain specific cases patients may volunteer  for the possibility of personal gain, such as a trial of a novel medication for an untreatable disease, but generally the motivation is, and should be, altruism. Clearly this is a vast improvement, but even this solution is not perfect. How do you do pediatric trials? You need the informed consent of the guardian, since the actual participant cannot give it. Can anyone really be "informed" of the risks without sufficient medical training? What about indirect coercion? It is illegal to force an unproven drug onto patients, but what about the case of a patient who does not have access to the normal standard of care? For them the only option might be the unproven drug, and in fact this does occur widely in the US and the developing world where universal health care is not available.

Finally, there is the issue of payment. It may make sense to pay for participation, but in that case the participant is not a volunteer and it opens the door to financial coercion. Yet if only unpaid volunteers are allowed, large demographic groups become under-represented in studies due to the inability to afford time off and transport costs involved in volunteering. To balance these conflicting interests, the ethical and legal rule in clinical trials is that you cannot pay volunteers, not provide a financial reward. You can, however, compensate them for their time and expenses. 

In other words, this is not how to recruit volunteers:

The UZ Leuven ethics committee really should take a walk around campus and look at the clinical trials recruitment flyers pinned up.

In the news: Flanders Today

Q&A

Professor Adrian Liston

Professor Adrian Liston of life sciences research institute VIB headed the Belgian-Australian research team that discovered the genetics determining the strength of the immune system.

Which missing link in the immune system did you find? 
We focused on the regulatory T cells, which determine how our immune system reacts to possible health threats. In short, these T cells are in charge of the activity of white blood cells – the cells that defend us against viruses. When there are not enough regulatory T cells, our immune system can be overactive and cause allergies or autoimmune diseases such as diabetes and arthritis. In the opposite case, an underactive immune system allows infections and tumours to grow. We have now identified the genetic programme that sets the number of regulatory T cells, which should help us to keep the immune system ideally balanced.

Until now, you have worked with genetically modified mice 
Yes; the next step is to design and test drugs for humans. We are contacting academic research groups and pharmaceutical companies. Basic medicine can be developed in a time span of five years, but the clinical trials to perfect the working of the drugs can take another 10 years. In the near future, our findings will hopefully help, for example, to kill off the remaining cancer cells after chemotherapy. Later, we hope to develop the means to give an 80-year-old back an immune system that is as strong as that of a healthy teenager.

Was the Australian connection coincidental? 
No, I have Australian roots and finished my PhD at the Australian National University in Canberra. During my research there, I collaborated with experts, including the Walter and Eliza Hall Institute in Melbourne. Four Australian scientists from this institute took part in this recent research project. The team in Flanders consisted of seven researchers at the Autoimmune Genetics Laboratory of VIB and the University of Leuven. Our project lasted four years and was funded by the Flemish Agency for Innovation through Science and Technology and the European Research Council. The results were published in the scientific journal Nature Immunology.

Interview by Andy Furniere

(see original in Flanders Today)