>> Falkai's answer, given from the perspective of a provider and clinical researcher: "We first have to invest in understanding the disease." One often has the impression that we have long known how illnesses arise, but with depression, for example, and many others others don't. It is now clear that environmental factors and plant-related factors interact, but: “We don’t know how exactly.”
Falkai: Health services research has the data and methods
Therefore, his first petition was: “We have to understand things better and incorporate them into model systems.” The crucial thing, however, is that as soon as a therapeutic principle or a molecule has been identified, it can be verified or falsified in a reasonable clinical trial. It then takes an average of around seven years until the first study results are available. And then another 15 years for the translation of a treatment principle that was found to be good into clinical care.
His next questions: Who actually says whether this is relevant for the sick person? What does this really do to improve the quality of life? This is exactly where health services research comes in,
which should enter into closer solidarity and closer cooperation with clinical research, because, according to Falkai: “Health care research has the data and methods to point clinical researchers to important topics.” Conversely, clinical researchers should also incorporate their results into the Feeding in health services research – “it should be a collaboration”. According to Falkai, this is the core theme of the congress with the subtitle: “Health care research – benefits for clinical practice. Potentials and perspectives.” In his opinion, it would be good if health services researchers and clinical researchers communicated much more closely, whether that be as part of a congress or when planning studies.
Correll: “Absolutely both
“Use research strands”
“Where the evidence from randomized studies ends, the baton of health care research should definitely be taken up,” explained Prof. Dr. Christoph U. Correll, Director of the Clinic for Psychiatry, Psychosomatics and Child and Adolescent Psychotherapy at the Charité Berlin, who spoke at the press conference about “the complementarity of health care research and clinical research.”
“Schung” emphasized. He certainly feels called upon to do this because he has published over 100 meta-analyses and a few more umbrella reviews and has carried out just as many registry studies. But this is mainly with data from American and Scandinavian patients, which is due to the sheer data availability. In this work it was noticeable that “many unmeasured and perhaps even measured but not included variables had an influence” on the outcome. This is due to the long-known problem of RCTs, in which attempts are made to exclude as much as possible everything that could create a bias: age groups, comorbidities, comedication, physical illnesses and much more. Correll: “We have a very narrow and clean sample, but relatively low external validity.”
In health services research, on the other hand, although the internal validity is weaker, there is strong external validity that can show how patients react to normal treatment. It is therefore essential to use both strands of research, as both support each other. However, health services research can also generate new data that has not yet been researched through randomized studies but should be researched with RCTs. Or through a “middle field of pragmatic studies” that would handle inclusion and exclusion criteria differently. However, this form of study is rarely used by the pharmaceutical industry for approval studies. However, he is convinced that it should be pushed for these to be carried out after approval - also by independent funding agencies. The reason: A Finnish work showed that 80 percent of patients who could be researched in randomized studies are excluded because of substance abuse, suicidality, comedication, etc. This not only means that the 80 percent who are not included have a worse outcome would, but we “may not be able to extrapolate all the data from the randomized studies”. <<