ideasIdea
A public equity index for trial sites and sponsors, tied to funding
Rank hospitals and companies each year on how well their trial participants match the people with the disease in their area, and use the ranking when deciding who gets public research money and trial contracts.
An independent body computes, for each site and sponsor, participation-to-prevalence ratios by race, ethnicity, age, sex and rurality across their oncology trials, publishes the index annually, and public funders and cooperative groups weight site selection and grant scoring by it. Sponsors use it in site selection.
Hypothesis
Public ranking with funding consequences will raise representativeness at low-ranked sites more than internal reporting does, by making equity a competitive metric.
Rationale
Public quality rankings changed hospital behaviour in surgery and infection control; trial equity currently has no comparable visible metric.
What would test it
Publish the index for two years; compare change in representativeness between sites in the bottom quartile and those above.
Maturity
speculative
Who has to act
policy
Cost to try
Small (under $1M)
Years to first evidence
2
Bottlenecks it attacks
- Trials do not represent the people who get cancer · Older, Black, Hispanic, Asian, rural, poor and multimorbid patients are under-represented, so results may not apply to them.
- Incentives reward me-too drugs and marginal gains · The system pays the same for a drug that adds two months as for a cure, so companies race to copy rather than to cure.