HEALTH officials who are to conduct surveys soon on clinical trials will find both self-interest and altruism as reasons why people offer themselves as subjects to test the efficacy and safety of drugs before they are approved for use.
Are Singaporeans more averse than people in other countries to participating in such trials and, if so, why? There are a handful of test regulars who find useful the modest payments they receive for trying out new medications.
Yet, by and large, clinical trials are a novel concept to Singaporeans.
Although such trials have more than doubled in the last decade from 99 to 253 and involve tens of thousands of volunteers, many Singaporeans are not familiar with them. Aversion is understandable. There appears to be a knowledge gap, allowing misconceptions, even superstitions, to persist, including the notion that it is bad luck to take medicine if one is not sick.
Apart from exploring attitudes, the surveys - among 1,000 patients beginning next month and 2,000 people later - should provide health officials an opportunity to offer general information and to raise awareness. They would then hopefully find more respondents indicating willingness to volunteer for the benefit of society, than suggesting readiness to take part purely for the money or for access to the latest drugs to treat their illnesses. The survey results will hopefully enable clinical trial planners to appeal as much, if not more, to people's civic sense than to less idealistic reasons for participation.
Whatever the motivation, however, prospective participants need to know that clinical trials here are as safe as they can be. The Health Sciences Authority regulates such trials as part of a robust regime that meets internationally recognised ethical and scientific standards. The Cabinet-appointed Bioethics Advisory Committee issues strict guidelines on ethical as well as legal and social aspects of medical research. For good measure, there is also the Singapore Guideline for Good Clinical Practice. Prospective participants should also be able to have reasonable confidence in privacy and confidentiality protection.
Again, whatever the reasons for participation, more volunteers are needed. With its racially diverse population, Singapore is well placed to conduct clinical trials, but participants may not be available in sufficient numbers, especially for later test phases that require larger sample sizes. For Singapore to establish itself as a biotechnology centre, it is important to chip away at the reluctance to participate in the crucial human-testing stage of the process.
This article was first published in The Straits Times on Oct 13 2008.
