Online gambling platforms now allow people to place bets on the likelihood of a drug trial succeeding. What could possibly go wrong?
US-based ‘prediction’ market platform Kalshi – an online gambling site which allows users to place a bet on any future outcome – now allows people to place bets on whether certain late-stage clinical trials meet their preregistered primary end points.
It’s probably not the best idea, say health policy and regulation experts.
The Kalshi clinical trials market only allows people to start betting once recruitment on a trial has closed – a move, according to an editorial published in Science, which was supposedly made to ensure that a visible price on the projected success of the trial would not sway recruitment.
Writing in Science, George Washington University health policy researcher Professor Y Tony Yang and Harvard Medical School regulation and pharmacy researcher Professor Aaron Kesselheim pointed out that the closing of patient enrolment is by no means the point at which outside influences would cease to impact a trial.
“A trial is engineered to control information: Randomization, blinding, and confidential interim monitoring keep chance imbalances, expectations, and emerging trends from distorting the comparison,” they wrote.
“A public price is a potent new channel into that environment: a number, updated continuously, framed as a probability that an outcome will be realized, backed by money at risk.
“It is also an unattributed number: A slide in price from 60 to 25 cents reads like a verdict that a trial’s goals are not expected to be met, whether it reflects a safety signal, a rumour, or thin trading.”
Theoretically, Professor Yang and Professor Kesselheim said, a participant could see a price fall and interpret it as a signal that the treatment was not working, and drop out of the trial altogether.
Or an investigator may score a subjective outcome differently.
Or a coordinator may work less to ensure participant compliance.
“Although we both know of no study showing that a public market changes trial participant behaviour or a trial result, the case for governance does not depend on such proof,” the researchers wrote.
“It rests on a plausible mechanism, an avoidable exposure, and an asymmetry of stakes: A delayed market can be reopened, but a compromised trial cannot be rerun.
“The effect may often be small, but is largest when end points are subjective, follow-up is long, and patients compare notes online.”
What’s more, the existing safeguards – trader employment verification and laws against trading with material non-public information (i.e. insider trading) – serve more to protect the market than to protect scientific integrity.
While Kalshi is currently unavailable in Australia, Aussies do famously love a punt – more so (on a per-capita basis) than any other nationality.
Given the hold that the gambling lobby purportedly has over the two major parties, and the financial and political heavyweights in favour of prediction markets, it seems to be a matter of time before Kalshi or one of its competitors reaches Australian shores.
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