A Breakthrough for Elderly in Drug Trials

Too many older Americans are sick, and too few of them are involved in groundbreaking drug trials. At least that's what President Clinton thinks. And so, pausing Wednesday before a diplomatic jaunt to Tokyo, Clinton issued an executive order ensuring that Medicare will cover the costs of members who choose to participate in clinical drug trials. Current reimbursement rules have discouraged older patients from becoming involved in the tests, Clinton says, because trial facilitators are never sure whether Medicare will cover any or all of the trials' often high costs. And as a result, only about 1 percent of older patients actually participate in the tests — even though that population is disproportionately affected by illness and disease.

"Clinical trials have been undersubscribed for years," says TIME medical contributor Dr. Ian Smith. "Too few people are involved, and as a result there aren't nearly enough trials." And that means potentially life-saving or -enhancing drugs aren't making it to market — a situation that leaves both drug companies and patients feeling cheated. The primary stumbling block for most clinical trials (as with all things medical) is the lack of funding; drug companies are permitted to subsidize part of the cost of the tests, but their involvement beyond a specific point is frowned upon by academics and doctors. Clinton's executive order, says Smith, addresses serious obstacles in the path of more effective trials, and could render the whole process more palatable to everyone involved. "Ordering Medicare funding will bring an underrepresented population into the tests," he says, "by allowing patients on fixed incomes or without private insurance to participate." In short, the pronouncement may signal a newly democratic spirit in the war against death and dying, allowing older Americans to join the fight as well.