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SUMMER
08
Letter from the Dean

Leslie Williamson
PHILIP A. PIZZO, MD
Philip Pizzo with a portrait of Levi Cooper Lane, The Founder of Cooper Medical College, which became Stanford Medical School.

Hardly a day seems to pass without a new headline about a clinical trial gone awry. At these moments, I think of the words of the late Scottish medical professor Archie Cochrane in his seminal textbook on evidence-based medicine. “The randomized controlled trial is a very beautiful technique, of wide applicability,” he wrote, “but as with everything else there are snags.” Well, we’re hitting some of those snags.

Critics offer a long list of mostly reasonable and often contradictory complaints: Trials overstate benefits, deliver conflicting findings, exclude the disadvantaged, exploit the disadvantaged, take too long, end too soon, cost too much, founder under government regulations, are unduly influenced by industry and all too often appear to spin results to boost profits.

The mounting frustration is eroding the public’s faith in medical science. And while government and the pharmaceutical industry must respond, so too must academic medical centers. In fact, we have the opportunity to take the lead in developing new approaches for translating basic scientific discoveries into therapies that alleviate suffering.

This issue of Stanford Medicine offers some promising ideas for reform, but none of them will put medical science back on track unless academic medical centers become the beachhead for the next wave of clinical trials.

The good news is that both the National Institutes of Health and the Food and Drug Administration recognize that academic medical centers are essential to developing the new genomic, molecular-science, imaging, statistical and informatic tools needed for the next generation of clinical trials. Federal officials are counting on us to identify the basic scientific discoveries with the most potential for yielding transformative drugs and diagnostics. Indeed, Stanford recently became part of a nationwide NIH-sponsored Clinical and Translational Science Award consortium that supports that exact mission. Encouraging policy makers to remain steadfast in their backing of these programs is paramount.

At Stanford, we are capitalizing on strengths in basic scientific research and collaborative spirit found at few, if any, other centers. These attributes have defined Stanford and will serve as our foundation even as we pursue the additional agenda of translating discoveries. We have also begun to work as a community without boundaries to determine when a basic insight or finding is ready for clinical application and are prepared to move that forward, marshalling the university’s wide range of expertise, including lawyers, economists, psychologists, computer scientists and statisticians, as well as bioscientists and physicians.

Many people will be surprised to discover that such research will have immediate benefits: Simply entering patients into clinical trials helps to organize — and enhance the quality of — their care and in some cases even improves survival.

And in the longer term I expect truly astonishing medical advances to come from our clinical trials. Medical science has in the last century virtually eradicated once-fatal diseases, made the world’s population healthier and generally prolonged humanity’s life span, and Stanford has played an important role in many of these developments. Now we are taking clinical research to a new level. In the coming years, Stanford researchers will continue to adopt new technologies and build partnerships across disciplines and outside of the university, but our underlying scientific principles must never be compromised. Our objectives remain the same: the search for concrete, unbiased evidence of a therapy’s efficacy, and the creation of new knowledge and insights that will help shape the treatment and diagnostic agenda of tomorrow.

With hope and optimism,
Philip A. Pizzo, MD
Dean
Stanford University School of Medicine
Carl and Elizabeth Naumann Professor, Pediatrics, Microbiology and Immunology

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