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Watch Out: Why study results are never as good in the real world

New drug out – huge hype – everyone should try it – and before too long, lots of reports about people for whom it didn’t work, or worse, people it actually harmed.

That’s because absolutely nothing ever works in the real world as well as it did in studies (or in ads, right?).

And the major reason for that discrepancy is because all drug studies load the dice preemptively to get the best possible results.

How? Simply by not enrolling (many?) patients in the study who might have a poorer response to the drug than the average otherwise pretty healthy people suffering from only the one problem that that drug is meant to allay.

In other words, studies tend to be full of people who might benefit from a drug and rather empty of people for whom the drug might fail.

Which is exactly what a recent analysis published in the journal JAMA Oncology found (and please excuse the medicalese), namely that “Among over 5,000 cancer patients surveyed, 37.2% of those with at least one comorbid condition had discussions about clinical trials compared with 44.1% of those with no comorbidities.”

In other words, in studying drugs for cancer patients, most of whom in the real world are very likely to have other health problems – since age is such a huge risk factor for cancer and the risk for nearly everything else also rises with age, too – researchers are much less likely to even discuss the merits of studying a new cancer drug with cancer patients who have other common health conditions than they are with cancer patients who are “younger, wealthier, more educated, more health literate, and more likely to be white”, and quite clearly, the latter are also much more likely to do well on the drugs being tested than your average cancer patient out there.

Anyway, bottom line: Next time you see major hype about a study of some new drug and you decide to run out and get that drug, step back a minute and tell yourself that you won’t know how well it works on people like you until it’s been out for a while, often a long time, and that’s true even if you’re white, young, wealthy, and have a PhD.

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