The end of randomised control trials is on the cards, a healthcare data expert predicts.
Speaking at the Wired Health conference, Martin Kohn, chief medical scientist at remote patient intelligence firm Sentrian, said the vast wastage of drugs coupled with the shift to personalised medicine would see randomised control trials having less of an impact in directing healthcare decision making.
“Current decision making is not good enough. We need to start looking at people and making personalised decisions – we need to make decisions that are better for individual patients,” he said.
At the moment, randomised control trials are limited in the level of information they can provide, he said. They don’t generate information about individual patients, the trials are conducted in an artificial environment and not in the real world, some results are flawed, and co-morbidities are generally not factored into trial design.
“This gold standard of research isn’t that golden,” he said. “If I’m going to learn about you, I need to look at you in the real world. We need to move away from randomised control trials and on to new ways of thinking about things and getting information. This is where big data comes in.”
Kohn admitted there would be challenges with this new way of working such as no controls and the possibility of random associations. The volume, velocity, variety and variability of data accessed in the real world could also be a problem, meaning sifting through the noise could be time consuming.
There was also the issue of being stuck under traditional old-style management or regulation, which was not aligned to these new ways of thinking.
However, Kohn believed the benefits were vast. He claimed big data and moving away from a reliance on randomised control trials would help the problems currently affecting global healthcare systems. He said the primary target should be focusing on high-cost patients and re-admissions, where the most benefit from real-world data would be felt.
“My prediction for the future is randomised control trials will be less important and they will only be for managing performance and not for making decisions.”