[Critical approach to clinical trials: difficulties of such research in Lebanon]

Clinical trials represent new steps in the progress of knowledge. Yet in spite of all the norms, guidelines and good clinical practices established since 1947, trials are still being published which seem to be, but in fact are not, well-conducted. Experts in planning and analyzing trial results have determined the factors that may affect clinical investigations at different phases. Among articles published over the last 30 years selected from Medline, one-third were biased. These biased articles were cited 2034 times. Clinical trials are designed to improve the treatment of particular diseases and to reduce mortality and morbidity. Nevertheless, other factors still appear to have an essential influence on the way clinical trials are conducted. It is surprising to see how often trials conclude that the drug of the pharmaceutical company initiating the study or funding it has the same efficiency, and sometimes is more efficient, than the drug it is being judged against. Perhaps, journals should objectively describe clinical trial protocols before publishing their results. Poor populations are still being abused by the pharmaceutical industry and more thought should be given to the notions of volunteers participating in trials and the compensation they receive. In Lebanon, the majority of these difficulties are encountered not only in multicenter international trials but are also seen in the lack of requirements for minimum safety measures and ethical standards when conducting national and regional trials. These insufficiencies raise important questions concerning their real objective.