Nikos pointed out this new york times article about poor clinical design killing people. For those of us who study learning from exploration information this is a reminder that low regret algorithms are particularly important, as regret in clinical trials is measured by patient deaths.
Two obvious improvements on the experimental design are:
- With reasonable record keeping of existing outcomes for the standard treatments, there is no need to explicitly assign people to a control group with the standard treatment, as that approach is effectively explored with great certainty. Asserting otherwise would imply that the nature of effective treatments for cancer has changed between now and a year ago, which denies the value of any clinical trial.
- An optimal experimental design will smoothly phase between exploration and exploitation as evidence for a new treatment shows that it can be effective. This is old tech, for example in the EXP3.P algorithm (page 12 aka 59) although I prefer the generalized and somewhat clearer analysis of EXP4.P.
Done the right way, the clinical trial for a successful treatment would start with some initial small pool (equivalent to “phase 1” in the article) and then simply expanded the pool of participants over time as it proved superior to the existing treatment, until the pool is everyone. And as a bonus, you can even compete with policies on treatments rather than raw treatments (i.e. personalized medicine).
Getting from here to there seems difficult. It’s been 15 years since EXP3.P was first published, and the progress in clinical trial design seems glacial to us outsiders. Partly, I think this is a communication and education failure, but partly, it’s also a failure of imagination within our own field. When we design algorithms, we often don’t think about all the applications, where a little massaging of the design in obvious-to-us ways so as to suit these applications would go a long ways. Getting this right here has a substantial moral aspect, potentially saving millions of lives over time through more precise and fast deployments of new treatments.