Research being conducted into stroke needs to slow down and take stock if a therapeutic breakthrough is ever likely to happen, says a leading stroke expert.
Professor Philip Bath, speaking at the British Pharmacological Society's Winter Meeting in London today (Tuesday), claims time and resources are being wasted because scientists and clinicians are failing to carry out what are termed 'systematic reviews' throughout the various stages of their research.
Systematic reviews are assessment of all research literature that could help address a carefully defined scientific problem. The aim is to provide a detailed summary of studies relevant to the research question.
"The concept of systematic review is to gather all the information, including research that is not published, in order to carry out a critical appraisal of the studies," said Professor Bath, Stroke Association Professor of Stroke Medicine at the University of Nottingham.
"A key component is defining the problem you wish to solve and then finding studies that address that problem. You can then use statistical techniques, known as meta-analysis, to appraise all the findings.
"If you go back 30 years, systematic reviews were rare and individual studies had to stand up to scientific scrutiny on their own but, now, the secondary research carried out through systematic review is just as important as the primary research.
"Systematic review and meta-analysis should be carried out at all stages of a research project from the stage of epidemiological and observational studies, then on to pre-clinical and animal studies, through to phase-II, phase-III and phase-IV clinical trials."
Professor Bath, whose own work on stroke is looking at stem cell therapies and how to manage high blood pressure in stroke, says that systematic review is even more critical in stroke research due to the complexity of the brain. Stroke is caused when a part of the brain is starved of oxygen through a disturbance to its blood supply.
"The brain is the most complex organ in the body, so research into stroke is very difficult. Dealing with a bit of dying muscle in the heart is relatively simple when compared to the brain and if part of the brain dies, as happens in stroke, it makes finding a treatment very difficult indeed.
"Since we know it will be difficult to find a successful therapy, researchers need to slow down and not rush the patent and funding clocks. Inevitably, there is a race to complete developments and this is stopping critical appraisal of the evidence. We even have situations where clinical trials are taking place before any preclinical work has been done, or where the preclinical data are not known."
Professor Bath points to the money that has been spent on 'neuroprotection' studies that attempt to slow down or put to sleep brain cells that have been starved of oxygen during stroke as a way to protect them.
"Billions of dollars have been spent testing this approach and there is very little to show for it," said Professor Bath. "The core things we do in clinical trials need to be done in preclinical studies and these should always be done first.
"Systematic reviews should be done throughout and examine negative and neutral studies as well as the positive. If we are ever going to beat stroke, researchers in the field have to pay proper due care and attention."
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