Imagine the thought process that goes into designing a building. One envisions the future use, the aesthetic value, and the cultural importance such a landmark will have on society. To say a building should just be judged on the fact that it either stands or falls is surely myopic and could even be dangerous. Teams of specialists and funders work together to make major projects happen, and even more diligently to sustain them.
Even laying the best plans rarely means that buildings survive the test of time. Consistently, society faces both novel threats and new needs, which can never be predicted and rarely ever quelled. Buildings with beautiful facades are gutted and retrofitted. Others are demolished and rebuilt. Changing a few thousand square feet of land can have long lasting impacts on an entire neighborhood, and in many urban centers, entire cities.
We have to whisk ourselves to Harry Potter land to find a building that can be a metaphor for the clinical trials process. That process has evolved in a relatively piecemeal and reactive manner much like the Burrow. As their family grew, the Weasley family added rooms and floors to make space in the Burrow; the end result being 7 precarious levels that remained standing only due to magic. Similarly, the clinical research process has evolved over the last century in a reactive search for certainty. In the face of public health crisis after crisis – from Ms. Winslow’s teething syrup to Thalidomide- the United States cobbled together a process that could produce an acceptable level of certainty about the safety and efficacy of treatments.
Do we let this system stand as it does today? Or do we buy the Weasley family a new mansion? One thing is for sure, the future looks even more uncertain than the last century. Perhaps, as long as we are prepared for it, we should be comfortable to live with some inevitable uncertainty in our world. And maybe, just maybe, our future deserves a house that gives a proactive resolution of complexity, rather than a reactive search for certainty.
Jen Bernstein and Sauleh Siddiqui