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An Urban Experience
J. Häggström1
1Professor, DVM, PhD, DECVIM-CA (Cardiology)
Why do we conduct clinical research? For who¨s benefit? The most straightforward answer to these questions are that we conduct clinical research to improve diagnostic methods and treatments, which in the end will benefit the general dog and cat population and their owners. Although this is probably true for many research projects, the reality is probably more complex. The last 20 years, original research designed for studying a clinical entity
or medical treatments have gradually increased, as indicated by increased number of publications and the complexity of studies. I have been fortunate to have been an active researcher during this very dynamic time period. This presentation is aimed at, to some extent, illustrate the development of different types of studies conducted in small animals. In the end, I as many other people engaged in clinical researchers, wonder if our studies truly made a difference in the end for owners, pets and practitioners.
New technologies and intergrity
There rate at which technical innovations are introduced field is high, but there are examples of studies where
new technologies are introduced that may not add much extra information to what is already known through case history, physical examination and routine clinical tests. There is a saying about these technologies: “another method desperately seeking an application”. Some of these technologies may be expensive, which means that researchers feel compelled to conduct studies. There are other examples where researchers need publications for their academic career or for prestige. In some instances, the reason for the publication is simply for marketing reasons. In these cases, the integrity of the researchers
is paramount to ensure that the results are correctly outlined in a non-biased manner and that negative results are also published.. Here it is the responsibility of the specialists that are engaged in the study to press the sponsor for a clause in the contract that states that the investigators have full right to proceed with publishing the trial regardless the outcome.
Different questions to answer require different clinical studies
Clinical studies do not need to be large and expensive
to provide clinical valuable information. Good new ideas and the formulation of questions to answer is a scarce commodity, and only the ingenuitivety sets the limits.
An example of studies that were very inexpensive and simple to perform includes the studies of sleeping and resting respiratory rates in normal dogs and cats and
in those with heart disease. These studies were very cheap to conduct, but provided valuable information
how to effectively home monitor dogs and cats with heart disease. Other studies, particularly those aimed
at evaluating responses to treatment, require large
study population, blinding and randomization which is expensive. The most challenging types of studies include chronic medication over a long time-period. It is tempting to extract as much information as possible these expensive trials, and a common problem is that they
are designed with too many questions to answer and
too complicated study protocol. The more questions to answer, the greater the chance is that the results become diluted and non-informative, and the compliance among clinicians and owners decrease with study protocol complexity. Therefore, the questions to be answered should be as few as possible and pertinent, and the study protocol should only include data that are needed for evaluating the primary outcome variable.
Some studies might not have been of direct benefit for the animals or owners but are needed to better characterize and define diseases. Case series are very common in veterinary medicine and they are limited
in value. For example, they cannot provide strong evidence of treatment effect unless a certain treatment lead to an outcome that never happens otherwise, but they serve to raise the awareness of a certain disease, and might be suggestive of a need for future studies. Studies of disease progression and staging might not either lead to a direct benefit. However, these types of studies constitute the foundation of large clinical trials that could not be appropriately designed without them. Epidemiological studies might serve to quantify a health problem within a breed and raise the awareness among clinicians, breeders and owners, but they do not provide a direct benefit for anyone. They are however essential in the next step for clinical decision making and for preventive measures aimed at reducing the occurrence of the disease. However, further studies might be needed before preventive measures are initiated. For example, breeding restrictions should not be applied unless evidence of inheritance is available. There are many example where this vital information is missing and measures are based on assumed inheritance.

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