International Clinical Trials Day: Two hundred and seventy-five years of research, and it all started with an orange

“If you don’t eat your veg you’ll get scurvy!”

Is that something you heard when you were younger? Or maybe older, if you’re a fussy one…

The discovery that scurvy was caused by vitamin C deficiency was the first-ever clinical trial, started by Navy surgeon James Lind on the HMS Salisbury on May 20th 1747. Until then, it had been long accepted that scurvy was just one of the risks you took when undertaking long voyages. The trial involved only twelve men put into pairs and given either cider, vitriolic elixir (diluted sulfuric acid), vinegar, seawater, two oranges and a lemon, or a purgative mixture. Only the two men receiving fruit began to recover; though it could be said that the men who received cider were less bothered by their symptoms than others.

Here’s a related fact for you: the term ‘limeys’ became somewhat of a derogatory term for the British, due to the sheer volume of limes and lime juice that ships procured and carried in order to ward off scurvy amongst the crew.

Alas, this piece is about research rather than etymology, so let’s get back to that.

Medicine has come a long way since 1747, but that first trial is commemorated on May 20th each year with International Clinical Trials Day (ICTD).

‘What’s this got to do with Huddersfield?’, I hear you ask. More than you might think, is the answer.

It’s true that this particular co-editor has a somewhat geeky interest in medical research, science and all things in between. So imagine my joy when I not only caught COVID-19 in October 2020 but ended up in hospital, where I was recruited to the Randomised Evaluation of COVID-19 Therapy (RECOVERY) Trial. Thrilled, I tell you.

Little did I know at the time that 18 months later, not only would I still be dealing with the physical impact of COVID-19, but also be involved in advocating for RECOVERY on behalf of Oxford University, and for clinical research as a Patient Research Champion for Calderdale and Huddersfield NHS Foundation Trust (CHFT). Being a research participant has brought opportunities to speak about my experience on behalf of RECOVERY, including a particularly nerve-wracking visit to the Academy of Medical Sciences in London last November.

As the only ‘normal’ person in the room – that being not a doctor, professor, scientist, and definitely not Sir Patrick Vallance (who was in attendance a̶n̶d̶ ̶s̶t̶o̶l̶e̶ ̶m̶y̶ ̶s̶e̶a̶t̶), it was daunting, to say the least, but I will share my talk with you. If you listen carefully you’ll be able to hear the protestors that were set up outside the Academy for the afternoon.

Another reason why this is relevant to Huddersfield is thanks to the incredible research team at CHFT, based in the depths of Huddersfield Royal Infirmary.

The thing with the RECOVERY trial, you see, is that whilst the concept and set-up of it was down to two Professors of Oxford University, the recruitment, implementation and data-gathering were implemented by NHS Trusts across the country, in hospitals just like ours, by their own research teams.

Tracy Wood, Clinical Research Nurse Manager at CHFT

RECOVERY made a big difference in the treatment of COVID-19 in a short space of time. Just three months after the RECOVERY Trial was established, results had already proven that dexamethasone – a cheap and readily available steroid – had a significant impact on the mortality rate of hospitalised COVID-19 patients. As time went on, other treatments were found to be beneficial.

Tracy Wood, Clinical Research Nurse Manager and Research & Innovation Lead, said on ICTD last year: “The RECOVERY Trial demonstrated a major benefit of dexamethasone and tocilizumab, which has impacted patient care throughout the world. To see these ground-breaking results makes me so proud to be a Research Nurse.

“I have never been more proud to lead research at CHFT. I am incredibly proud of everyone for embracing clinical research despite the difficulties we have all faced. Together we have found innovative ways to deliver clinical research and can demonstrate research excellence.”

The CHFT Research team have been recognised for their hard work and success, winning the 2020 Nursing Times Award for Clinical Research Nursing, due to their efforts in engaging staff in clinical research. Just this week, Dr Purav Desai (Principal Investigator for the RECOVERY Trial at CHFT) was awarded Principal Investigator of the Year at the Yorkshire and Humber region’s Clinical Research Network Awards held in Leeds.

Dr Purav Desai, CHFT Research Principal Investigator

Purav was nominated by Tracy, backed by the whole Research Team, who were in awe of the way he led the COVID-19 RECOVERY Trial at CHFT.  Speaking the following morning, Purav said: “I’m feeling really emotional and humbled this morning. It really is a team effort”.

Chief Executive Brendan Brown, added: “Your leadership, tenacity and commitment to this trial has proved CHFT has a real role to play in research”. 

Medical Director, David Birkenhead, said: “What a fantastic and well-deserved achievement, which inevitably has contributed to better health for our local population, the UK and beyond”.

To date Calderdale & Huddersfield NHS Foundation Trust has recruited more than 600 patients to the trial, making them the highest recruiting Trust in the Yorkshire and Humber region, a status that they have maintained throughout the pandemic. 

While we can celebrate achievements such as Purav’s above, ICTD this year is focusing on those individuals whom without their help and commitment, clinical research could not happen – the participants.  Patients being treated at the Trust who give themselves, their trust and their time to help us find new ways of improving outcomes for patients with many different ailments.  ICTD is our shout out to them this year.

Clinical research has a bizarre sort of stigma attached to it, I find. The reactions I’ve had when telling people that I took part in medical research have been many and varied. Some are intrigued, some surprised, and others downright appalled. “Why would you do that?”, they ask.

To answer that question, I’ll have to quote myself.

“When I’m asked why I was so eager to take part in RECOVERY, my answer is very simple.  One, I love science, I trust science.  Two, I trust the NHS completely.  And three; somebody has to do it. We all want ‘better’ – better cancer treatments, better cold and flu remedies, better contraceptives – and for that, research has to happen.  Someone, somewhere, has to put their faith in science and just do it.  I’m more than happy to be one of those people.”

I’ll be spending International Clinical Trials Day feeling particularly grateful to all the medics, scientists and patients that have contributed to the advancement of medicine since James Lind chopped up some fruit on May 20th 1747.

Courtesy of Health & Wellbeing | Huddersfield Times