Acro-batics

The clinical trials of new drugs and interventions are unwieldy beasts. They can span many years, multiple hospitals, and thousands of patients. The trials generate reams and reams of data, and drawing the proper conclusions requires painstaking statistical interpretation.

Each trial has the potential to be noteworthy, to change practice and save lives. But how do you encapsulate that promise, how can you keep the study on your colleagues' minds during the long slog before publication?

A catchy study title helps.

A little digression: I was commenting on Intueri's post about the lack of evidence-based guidelines in psychiatric interventions. I suggested such protocols often grow out of the acute care experience, but she pointed out many psychiatric sitations are indeed acute.

I was going to suggest a study, along the lines of some memorable clinical trial acronyms, like PIVOT and CASANOVA. I came up with CALM: the Clinical Acuity-Lessening Medication trial. Unfortunately, it's already taken: Candesartan and Lisinopril Microalbuminuria study.

Damn. And I soon learned just how many clinical trials have contrived acronym, browsing this extensive list. Sure, these massive studies can seem boring, and lead investigators -- like anyone -- need some amusement to spice things up. But I think some of these scientists were trying too hard:

  • AWESOME -- Angina With Extremely Serious Operative Mortality Evaluation
  • BATMAN -- BiodivYsio® BATiMastat SV stent versus balloon ANgioplasty
  • HeADDFIRST -- Hemicraniectomy And Durotomy for Deterioration From Infarction Relating Swelling Trial
  • IMPRESS -- Inhibition of MetalloProtease by BMS-186716 in a Randomized Exercise and Symptoms Study;
  • PROVE IT -- PRavastatin Or atorVastatin Evaluation and Infection Therapy;
  • SHOCK -- SHOuld we emergently revascularize occluded coronaries for Cardiogenic shocK

  • Seriously, how can people keep a straight face at cardiology conferences?

    "Oh yeah, Bob, it's easy enrolling candidates for the AWESOME study."

    "Great, John. But we're under a lot of pressure in the PROVE IT trial to, you know, prove it. Hey, over there -- who's that guy?"

    "That's Batman."

    As ridiculous as that sounds, you have to pity the clinicians participating in trials that just didn't try hard enough, namewise:

  • ACME -- Angioplasty Compared to MEdicine
  • CASH -- Cardiac Arrest Study, Hamburg
  • REVERSAL -- REVERSal of Atherosclerosis with Lipitor™
  • or look at the 7 (!) trials that lay claim to "SMART".

  • The best scenario comes when an acronyms strikes just the right balance, appearing both clever and fun, maybe spelling a word at least tangentially related to the study:

  • AT LAST -- Antiretroviral Trial Looking At Sex and Treatment
  • MAGIC -- MAGnesium In Coronary arteries
  • PEACE -- Prevention of Events with Angiotensin Converting Enzyme inhibitor
  • RHYTHM -- Resynchronization for Hemodynamic Treatment for Heart failure Management
  • SIESTA -- Snooze-Induced Excitation of Sympathetic Triggered Activity

  • Scroll through the list, find your favorite. It's comforting to see our best minds are studying LIFE and LIMB, MIRACLE and MIRAGE. The aforementioned CALM is balanced with EXCITE. You can also learn the difference between SYMPHONY and OPERA. As for more conventional names: ADAM, DAVID, MONICA, RUTH, and SONIA are all ALIVE, with VIGOR and GUSTO.

    There are too many more to mention, though I was a little dismayed to find the really memorable ones were often sponsored by pharm companies. Though they're catchy, I have no idea if the studies are well-conducted, or tell us anything important. For this reason, I'd like to organize a study examining whether clinical trials with fancy acronyms have higher impact than serious studies denoted by plain collections of letters. We'll call it ABSURD -- Acronym Behavior overShadowing Useful Results and Data.