Malani Argues Drug Research Loses Momentum as Patients Choose Existing Treatments Over Clinical Trials

Therapeutic success stifles medical progress
Heidi Ledford
May 24, 2011

Is medical research a victim of its own success? A surprising economic analysis suggests that each new medical innovation may make the next more difficult to achieve, because patients prefer to stick with proven — though potentially inferior — treatments rather than trying something new. Good effectively becomes the enemy of great.

The finding confirms the experience of many medical researchers struggling to recruit patients for their next clinical trial. But the solution proposed by the study's authors — to pay trial participants higher stipends — makes some clinicians queasy.

The analysis1, published this month by the National Bureau of Economic Research based in Cambridge, Massachusetts, shows that the percentage of HIV-infected men who enrolled in clinical trials plummeted immediately after a regimen of antiretroviral drugs known as HAART hit the market in 1996 (see 'The price of success'). The precipitous decline, seen in data from the Multicente