EVOLUTION OF CLINICAL RESEARCH

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EVOLUTION OF CLINICAL RESEARCH – THE HISTROY BEFORE AND AFTER JAMES LIND

"The charm of history and its enigmatic lesson consist in the fact that, from age to age, nothing changes and yet everything is completely different." - Aldous Huxley

The Evolution the Clinical Research explains a long and fascinating journey. The history of clinical research which is being recorded goes back to the biblical descriptions in 500 B.C.The journey of this evolution starts from the dietary therapy i.e., legumes to lemons and then to drugs. This blog captures the major milestones in the evolution of the clinicaltrial.

     

The world’s first clinical trial was recorded in the “BOOK OF DANIEL” .The clinical trail was not conducted by a medical physician but a King Nebuchadnezzar; he was a resourceful military leader. In his rule in Babylon, he ordered the people of his country of one group to eat only meat and drink wine only, a diet he believed that would make them to have a good physical condition.  Moreover, asked the other royal blood group to eat only vegetables, but they refused to eat .Then the asked them to eat the legumes and water for a period of 10 days. Now the experiment of Nebuchadnezzar was completed. After that he got a conclusion that those who have ate the vegetables are very well nourished that meat eaters. Therefore, he asked people to continue eating vegetables to continue their diet. This was the first time in the evolution of human beings as an open controlled experiment concluded with a good decision of public health.

1747: JAMES LIND AND SCURVY TRIAL

James Lind is the first physician to conduct a clinical trial of the modern era. When he was working as a surgeon on a ship, he was appalled with high mortality rate of scurvy among the sailors. Then he planned for a comparative trial for the cure of scurvy. He had vivid description for the trail including all the elements of a controlled trial.

Lind described that on 20th may of 1747 he selected 12 patients who are suffering with the scurvy and gathered them at Salisbury Sea. In addition, mentioned that all the cases were similar in with general symptoms of putrid gums, the spots and lassitude, with the weakness of knees. All the people who are with scurvy. All of them are given with same diet viz., water gruel sweetened with sugar in the morning; fresh mutton-broth often times for dinner; at other times light puddings, boiled biscuit with sugar, etc., and for supper, barley and raisins, ricae and currants, sago and wine or the like.  Supper, barley and raisins, ricae and currants, sago and wine or the like.  

Two of them ordered each a quart of cyder a day. Two of them took 25 drops of elixir vitriol three times a day.two of them took two spoonful of vinegar three times a day .Two of them were put on the sea water .Finally two of them had each two oranges and a lemon each day.So, finally the patients who had oranges and lemon are showing visible good effects.The person who had these at the end of the week that he is fit for duty. Moreover, the other was also cured by the lemon and oranges and he can join after recovering.

Although that the results of the scurvy are good. He did not recommend them to eat oranges because they are expensive those days. So based on that it was really 50 years before the British Navy they made the lemon juice compulsory in their diet.

                        So, because of the clinical trial conducted by James Lind was successful and it was the first clinical trail .so, may20 is regarded as “THE INTERNATIONAL CLINICAL TRIALS DAY”

AFTER JAMES LIND:

1800:ARRIVAL OF PLACEBO:

It took for about a century to another important mile stone in the history of the modern clinical trail.i.e,The placebo.It was the word which appeared first time in the medical literature  in early 1800.In 1811,Hooper’s medical dictionary defined it as a “An epithet given to any medicine more to please than benefit the patient.”Later in 1863 U.S Physician Austin planned a clinical trail by comparing it with a inefficient remedy.He conducted the clinical trail on 13 patients who are suffering from Rheumatism with the herbal extract instead of the actual remedy.This was given regularly as “placeboic remedy for Rheumatism”.The progress in this treatment gave confidence to the patients.

CONCLUSION:

Although there are various no of clinical trails being conducted after the arrival of the placebo such as in 1943-the double bind controlled clinical trail –patulin for common cold,in 1946-the first randomised clinical trail was conducted .these clinical trails led to the evolution of clinical trails in india and also formation of the ethical and regulatory frame works.

1) Kalangi mounica grace Robert, 4th year ,B.Pharm.

2)S.V.Manideepika,4th B.Pharm

Annamacharya college of pharmacy ,rajampeta, kadapa