Outsourcing Research?

A Wall Street Journal article reports that many drug companies are going to Finland for drug research. It is thought that study subjects there are more compliant, with low drop out rates. We have heard of similar interest in India and China.
Most of the research is done by changing a single variable. For example, half the patients given a study medicine are compared to the half that are not given that medicine. We try to measure the effect of a medicine in real life scenarios; that is an interaction of medicine with how study subjects live, what they eat, how active they are, the air they breathe, their ethnic background, and much more.
We have now recognized that people can have unique response to disease and treatment based on their gender, ethnicity etc. Against that background, should we apply the research data obtained on a different population to the patients in the US? Should FDA approve the drugs for use in the US based on research done on subjects on another continent?
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Six Things You Must Know About Heart Disease

1. No, you are never too young to be thinking of your heart.
2. We talk about heart disease, and heart attack comes to mind. In addition to blockage of heart arteries, several other problems can affect this organ . There can be problem with wiring of the heart causing heart to go too fast or slow or erratic. There can be problem with heart muscles leading to heart failure. There can be shrinkage or leakage of the heart valves or other structural abnormalities.
3. A concern for heart attacks makes us think of heart disease in local terms. We just tend to think of blockages that need fixing. The heart arteries are part of body’s plumbing system that runs from head to foot. Persons who have heart attack tend to be at a higher risk for stroke and vice versa. This makes a strong case for thinking of heart disease in systemic rather than local terms. Systemic approach should involve controlling the risk factors for heart disease aggressively.
4. Not too long ago, we used to think that heart artery blockages progress over time (progressing from 50 to 60 to 70 percent and so on), and eventually cause heart attack. Later studies suggested that most of the heart attacks are caused by the arteries that are less than 50% blocked. These are the blockages that are hard to detect through commonly used tests. I am saying this to make a case for effective proactive approach and not to convey a defeatist attitude. A proactive approach involves controlling risk factors for heart disease like high blood pressure, diabetes, high cholesterol, smoking, physical inactivity etc.
5. Cardiology (study of heart) is a rapidly evolving field. There was a time when people used to think that high blood pressure is an essential part of growing old. There was a time when swollen heart failure patients were treated by bloodletting mistakenly thinking that it will help them. The concept of intensive care unit treatment of heart attack patients has, and continues to save numerous lives.
6. And most important, it is possible to have perfectly normal life after heart problem. Quite often my patients have told me, “This heart attack was a wake up call for me. Now I eat right and exercise daily. I am feeling better than I have felt in a long time”.
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