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Biological bias
LEADERS
Editorial Editor Emily Wilson Managing editor Rowan Hooper Art editor Craig Mackie Editor at large Jeremy Webb
News Chief news editor Niall Firth Editors Penny Sarchet, Jacob Aron, Timothy Revell, Jon White
SPENCER PLATT/GETTY
Reporters (UK) Andy Coghlan, Alison George, Jessica Hamzelou, Michael Le Page, Clare Wilson, Sam Wong (US) Leah Crane, Chelsea Whyte (Aus) Alice Klein
Features Chief features editor Richard Webb Editors Catherine de Lange, Gilead Amit, Catherine Brahic, Julia Brown, Daniel Cossins, Kate Douglas, Joshua Howgego, Tiffany O’Callaghan, Sean O’Neill Feature writer Graham Lawton
Culture and Community Editors Liz Else, Mike Holderness, Simon Ings, Frank Swain
Subeditors
Biological bias We must make clinical trials fairer for all
Chief subeditor Eleanor Parsons Tom Campbell, Hannah Joshua, Chris Simms
Design Kathryn Brazier, Joe Hetzel, Dave Johnston, Ryan Wills
Picture desk Chief picture editor Adam Goff Kirstin Kidd, David Stock
Production Mick O’Hare, Melanie Green , Alan Blagrove, Anne Marie Conlon
Contact us newscientist.com/contact General & media enquiries Tel +44 (0)20 7611 1202 [email protected] UK 25 Bedford Street, London, WC2E 9ES Tel +44 (0)20 7611 1200 AUSTRALIA Level 10, Suite 13, 418A Elizabeth Street, Surrey Hills, NSW 2010 US 210 Broadway #201 Cambridge, MA 02139 Tel +1 617 283 3213
TO EVALUATE a new drug, you need a clinical trial that’s designed to most clearly reveal its effects. Test it in too variable – or too sick – a group of people, and you are less likely to pick up the powerful effects you hope it is capable of. That’s just statistics. But such efforts to get the clearest signal have led drug developers to skew clinical trials to one particular group: white people. As many as 86 per cent of participants in drug trials are white, according to one 2014 analysis. This is a problem: a person’s ethnicity can influence how effective or dangerous a drug is, as can their age, gender or weight. Testing a drug on a group
that doesn’t represent the wider population means that guidelines on how to use it will then largely apply only to a subset of people. In the past, many explanations have been put forward for the low numbers of, for example, African Americans in clinical trials. These included lower awareness of trials, low numbers of black biomedical researchers, and a historically justified lack of trust in the US medical establishment. But it’s time to face the fact that the entry requirements are also against them. Just as women have been excluded from research due to fluctuating hormones, minority volunteers can be rejected from
Conceptual difficulties
© 2018 New Scientist Ltd, England New Scientist is published weekly by New Scientist Ltd. ISSN 0262 4079. New Scientist (Online) ISSN 2059 5387 Registered at the Post Office as a newspaper and printed in England by William Gibbons (Wolverhampton)
WHAT hope has consciousness of understanding the world, when it doesn’t yet understand itself? The answer is we don’t know – but it’s a blast trying to find out. Science is the art of asking hard questions and, whether or not we find answers, finding new perspectives that extend our knowledge. Often those perspectives are
truly mind-blowing, as our special feature “How to think about…” makes plain (see page 28). You might dispute our choice of 13 of the most intriguing ideas from science and technology – indeed, when we undertook a similar exercise in 2014, the list was entirely different (13 December 2014, p 32). But all exemplify how scientific
trials due to stats that gauge their health. For example, over-reliance on crude markers for kidney or immune health may explain why so few black men are included in prostate cancer trials, despite the disease being more common in this group (see page 15). This is of particular concern given that minority groups often experience worse health than the population average. So how can we better represent real populations and still detect benefits of new drugs? Bigger trials or extra trials in subgroups may help, although both will cost more money. Whatever we do, what’s certain is that we must act. n
enquiry defines and shapes our thinking in often unexpected ways. They illustrate the beauty of the subject: how it follows no agenda or preconceptions, but guides us on a stumbling path to greater enlightenment. Science may often be hard to get our heads around, but to echo the ending of our special feature: it is the worst way of seeking truth, apart from all the others that have been tried from time to time. n 30 June 2018 | NewScientist | 5
Editorial Editor Emily Wilson Managing editor Rowan Hooper Art editor Craig Mackie Editor at large Jeremy Webb
News Chief news editor Niall Firth Editors Penny Sarchet, Jacob Aron, Timothy Revell, Jon White
SPENCER PLATT/GETTY
Reporters (UK) Andy Coghlan, Alison George, Jessica Hamzelou, Michael Le Page, Clare Wilson, Sam Wong (US) Leah Crane, Chelsea Whyte (Aus) Alice Klein
Features Chief features editor Richard Webb Editors Catherine de Lange, Gilead Amit, Catherine Brahic, Julia Brown, Daniel Cossins, Kate Douglas, Joshua Howgego, Tiffany O’Callaghan, Sean O’Neill Feature writer Graham Lawton
Culture and Community Editors Liz Else, Mike Holderness, Simon Ings, Frank Swain
Subeditors
Biological bias We must make clinical trials fairer for all
Chief subeditor Eleanor Parsons Tom Campbell, Hannah Joshua, Chris Simms
Design Kathryn Brazier, Joe Hetzel, Dave Johnston, Ryan Wills
Picture desk Chief picture editor Adam Goff Kirstin Kidd, David Stock
Production Mick O’Hare, Melanie Green , Alan Blagrove, Anne Marie Conlon
Contact us newscientist.com/contact General & media enquiries Tel +44 (0)20 7611 1202 [email protected] UK 25 Bedford Street, London, WC2E 9ES Tel +44 (0)20 7611 1200 AUSTRALIA Level 10, Suite 13, 418A Elizabeth Street, Surrey Hills, NSW 2010 US 210 Broadway #201 Cambridge, MA 02139 Tel +1 617 283 3213
TO EVALUATE a new drug, you need a clinical trial that’s designed to most clearly reveal its effects. Test it in too variable – or too sick – a group of people, and you are less likely to pick up the powerful effects you hope it is capable of. That’s just statistics. But such efforts to get the clearest signal have led drug developers to skew clinical trials to one particular group: white people. As many as 86 per cent of participants in drug trials are white, according to one 2014 analysis. This is a problem: a person’s ethnicity can influence how effective or dangerous a drug is, as can their age, gender or weight. Testing a drug on a group
that doesn’t represent the wider population means that guidelines on how to use it will then largely apply only to a subset of people. In the past, many explanations have been put forward for the low numbers of, for example, African Americans in clinical trials. These included lower awareness of trials, low numbers of black biomedical researchers, and a historically justified lack of trust in the US medical establishment. But it’s time to face the fact that the entry requirements are also against them. Just as women have been excluded from research due to fluctuating hormones, minority volunteers can be rejected from
Conceptual difficulties
© 2018 New Scientist Ltd, England New Scientist is published weekly by New Scientist Ltd. ISSN 0262 4079. New Scientist (Online) ISSN 2059 5387 Registered at the Post Office as a newspaper and printed in England by William Gibbons (Wolverhampton)
WHAT hope has consciousness of understanding the world, when it doesn’t yet understand itself? The answer is we don’t know – but it’s a blast trying to find out. Science is the art of asking hard questions and, whether or not we find answers, finding new perspectives that extend our knowledge. Often those perspectives are
truly mind-blowing, as our special feature “How to think about…” makes plain (see page 28). You might dispute our choice of 13 of the most intriguing ideas from science and technology – indeed, when we undertook a similar exercise in 2014, the list was entirely different (13 December 2014, p 32). But all exemplify how scientific
trials due to stats that gauge their health. For example, over-reliance on crude markers for kidney or immune health may explain why so few black men are included in prostate cancer trials, despite the disease being more common in this group (see page 15). This is of particular concern given that minority groups often experience worse health than the population average. So how can we better represent real populations and still detect benefits of new drugs? Bigger trials or extra trials in subgroups may help, although both will cost more money. Whatever we do, what’s certain is that we must act. n
enquiry defines and shapes our thinking in often unexpected ways. They illustrate the beauty of the subject: how it follows no agenda or preconceptions, but guides us on a stumbling path to greater enlightenment. Science may often be hard to get our heads around, but to echo the ending of our special feature: it is the worst way of seeking truth, apart from all the others that have been tried from time to time. n 30 June 2018 | NewScientist | 5