One of the best editorials I have read in recent times and it addresses a number of key issues. Please read it in the light of how conformal radiation gave way to image guidance and modulation in radiation therapy without doing any randomised studies. The emphasis remains mine.
But a palpable sense of urgency and a lingering concern that “in critical situations, large randomized controlled trials are not always feasible or ethical” perpetuate the perception that, when it comes to the rigors of science, crisis situations demand exceptions to high standards for quality.
Early phase studies have been launched before completion of investigations that would normally be required to warrant further development of the intervention, and treatment trials have used research strategies that are easy to implement but unlikely to yield unbiased effect estimates.
Numerous trials investigating similar hypotheses risk duplication of effort, and droves of research papers have been rushed to preprint servers, essentially outsourcing peer review to practicing physicians and journalists.
Although crises present major logistical and practical challenges, the moral mission of research remains the same: to reduce uncertainty and enable caregivers, health systems, and policy-makers to better address individual and public health.
Rather than generating permission to carry out low-quality investigations, the urgency and scarcity of pandemics heighten the responsibility of key actors in the research enterprise to coordinate their activities to uphold the standards necessary to advance this mission.
While generating a moral argument for research, it is important to underscore the fact that the usually comatose research machinery has sprung into action and any research group reporting any benefit (if at all) would help them burnish their credentials. While this, of course, is a very cynical statement, the overwhelming din is a clear pointer to this fact. The only proven effect is a lockdown; vaccine would take aeons to mature (even if it does).
The editorial is worth reading in its entirety and as radiation oncologists, we should stop, ponder and think about the “evidence” for stereotactic radiation or supranormal doses of XRT given without emphasising on radiation biology. We are not in a hurry but our best interests should be patients and not a “late-breaking abstract in a fancy conference.