My life as a guinea pig

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My life as a guinea pig

BMJ 2006;332:735 (25 March), doi:10.1136/bmj.332.7543.735

Reviews, Personal views

Last week six young men taking part in a phase I trial in London

became severely ill after being given a new drug. At least one of

the volunteers who ended up in the intensive care unit at Northwick

Park Hospital was using the money to pay off debts, press reports

said. People in need of extra cash see medical trials as easy money.

Medical students, with six years in which to build up debt, find the

prospect of a large lump sum alluring. We are also considered

excellent trial participants: we are young and healthy, in one place

for a long time, and are not scared of hospital environments.

Studies are usually advertised on hospital notice boards. They are

also advertised in newspapers, with lines such as " make money in

comfortable surroundings. " After all, this is not work: you just

have a few injections. Word spreads quickly among friends. People

tip each other off with comments such as, " You're a right handed

male. Go for this one. It's great money. "

For about the same wage, trial participation is considerably more

interesting than a supermarket job

I have completed 16 studies over my years as a medical student,

ranging from a one-off chest radiograph to a multipart trial over

several months. I have regressed to childhood under hypnosis, had

numerous electroencephalograms, and been told that I have a lovely

gastrooesophageal junction.

But when I coughed up blood for the fourth time one morning, I

thought: " Why am I doing this to myself? " I had just finished

undergoing my first bronchoscopy, as part of a study looking into

the effects of the cold virus on people with asthma. For three

bronchoscopies and a nasty cold I would receive £500.

However, I dropped out of this study after the first bronchoscopy. I

took longer than the expected one day to recover from it, and for a

week I couldn't run without wheezing. I felt that the money offered

to me didn't compensate for three weeks of feeling awful. The doctor

running the unit was understanding and did not push me into

completing the study. But I still hate the fact that I ended up as

the " drop out " in their statistics and feel guilty about the time

put into my work up. Would I do another trial with invasive

procedures again? Maybe, but next time I would make sure I fully

weighed up the benefits of the money against the potential side

effects before deciding to take part.

Compensation is only for time and inconvenience, and at my

university payments are capped, so that no one is tempted into

studies through financial hardship. If you include time spent on

travel and baseline tests, a large trial might work out at only

about £5 to £10 an hour. But for about the same wage, trial

participation is considerably more interesting than a supermarket

job. It is never monotonous, can be written off as revision time

near exam periods, and still conveys a sense of wonder about the

science. Also, undergoing many of the investigations that I may have

to describe to future patients is probably not a bad thing. However,

it is well known among medical students that the really good money

is to be found in the drug trials run by independent units.

I have never participated in a drug trial. The unknown side effects

of an untested product in my body were past the limits even of my

entrepreneurial spirit. But thousands of people have bronchoscopies

every year. The major complications have occurred enough times that

their risk can actually be quantified. The extremely small risk of a

perforation during bronchoscopy was one I could objectively weigh up

before deciding to take part in that study.

However, I would not test the HIV vaccine I saw advertised. The

theoretical risk of a new HIV vaccine reverting to wild type is one

that I would not be prepared to take.

One of my medical student friends took part in a drug trial for a

vaccine against the human papillomavirus. The success of the trial

may result in many women being protected from cervical cancer. She

entered the trial from a purely altruistic motive, and for her the

payment was just a bonus. She is proud that a trial she participated

in has yielded such worthwhile results and, despite the potential

risk to her health, would consider taking part in another trial.

Indeed, many patients have benefited from the volunteers' readiness

to take on risk.

From August I will finally be earning a salary, and my career as a

serial trial participant will come to an end. And not before time,

as my body probably needs a rest from invasive procedures—although,

when I told my respiratory consultant, he haughtily informed me that

in his day as a student he underwent 29 bronchoscopies for a single

study, all without sedative. Perhaps medical students aren't the

experimental subjects they used to be. (See News, p 683.)

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Kate Mandeville, final year medical student

Imperial College London kate.mandeville@...

http://bmj.bmjjournals.com/cgi/content/full/332/7543/735