Your report on drug trials in India (14 November) fails to state that the 1,600 international clinical trials conducted in India since 2005 represent less than 1.5 per cent of worldwide clinical trials during that period.
Given that India houses 15 per cent of the world's population and 20 per cent of the global disease burden, India's participation in clinical trials is much too limited and must be increased.
India's participation reduces the cost and timeline of drug development because India's hospitals are able to recruit more patients than in Western countries, not because of lax regulation but because of disease burden and unmet medical need. Indian patients who elect to participate in clinical trials gain access to innovative treatments often with life-enhancing benefits. Patients allocated to the control arm of the study receive the accepted standard of care.
Clinical trials bring in research grants and hospital payments that improve facilities for all patients – of particular value in India's poorly funded government hospitals. Engaging physicians in international clinical research improves their practice of evidence-based medicine, record-keeping and patient communication.
Of course it is imperative that all stakeholders fully comply with the highest standards of informed consent and data quality, and that there be harsh penalties for non-compliance.
But while campaigners do well to highlight the complexities associated with clinical-trial conduct, by failing to appreciate the whole picture they are placing India's fledgling clinical-trial industry at grave risk. They must remember that any consequently declining clinical-trial activity in India will be detrimental not only for patients around the world, but most particularly for the Indian patient.
Dr Nermeen Varawalla
Founder & CEO, ECCRO
The Association of Clinical Research Organisations (Acro) fundamentally disagrees with the premise of your report. Clinical-research organisations fully acknowledge our responsibility to adhere to the same high standards of ethics, safety and quality wherever in the world trials are conducted.
India represents a tremendous opportunity for research that will advance treatments and improve the quality of life for millions of patients around the world, including in India. Acro is involved in dialogue with regulators in India and around the world to ensure that trials are conducted in patients' best interests and in adherence to international standards.
There are many important reasons to conduct research globally: physician and patient participation rates are much higher globally than in the US and western Europe; and some diseases, such as malaria, are more prevalent in certain geographic areas.
Above all, conducting clinical trials globally dramatically accelerates the drug-development process, sometimes reducing by half the time in which new treatments can be delivered. This translates into life-saving treatments reaching patients, all over the world, years sooner.
Vice-president of Public Affairs,
Association of Clinical Research Organisations, Washington DC
Britain still mired in imperial past
I am a European. Perhaps this is because I am one of a generation who spent part of their childhood in air-raid shelters, and I find it wonderful that I can travel in peace without hindrance from Ireland to Hungary, and from Poland to Greece.
I feel ashamed that so many of our political leaders are stuck in an imperial past, unable to see a vision of the future in which we play our part in leading a Europe for whose peace and democracy our nation has given so much.
Our leaders seem to take a narrow view of short-term self-interest, pandering to those who believe that the British are superior to and more competent than other peoples.
Have we no politician who is brave enough to take us wholeheartedly into Europe? Let us be part of the eurozone, and help to make Europe a stronger counterweight to China, the US and India.
Mr Cameron states his objective as being to protect the interests of the UK. Can he not see that our true interest lies in being part of something greater, not in being isolated and resented? Can he not see that we ourselves would be greater if we cared for a greater Europe?
Those who have compared David Cameron to Neville Chamberlain are more correct than they know. Chamberlain, too, was unprepared to engage with Europe's problems and ducked sacrificial involvement in the crises of 1938. Anti-European sentiment and Little England isolation were as popular then as now, hence Chamberlain's rapturous reception for delivering "peace in our time".
Similarly, the connection between the political and the financial elites encouraged the view that Britain's interests were overseas and not in Europe. There are people even now who think the price of the Empire was not worth the fate of Czechoslovakia, Poland or even France. After 1938 British foreign policy was marginalised and reactive. It is clear that is how events will unfold from now on, too.
If anyone thinks that the City of London, which enabled British power projection in both formal and informal empires for two centuries, will be able to carry on doing so, even unregulated, when the world is shifting eastwards, then they are misled.
At least Chamberlain woke up and behaved honourably after September 1939: if Cameron has a comparison, might I suggest Lord Halifax?
Dr Philip Brindle
David Cameron was quite right to say no to these desperate proposals to give more powers to Europe over our affairs.
It will now take trillions of euros to patch up the growing list of countries forming a queue for help which may eventually overcome the stability of Europe and lead to the death of the euro.
So now it seems our Government is not to be "led by Brussels" but by a small clique of navel-gazing, dyed-in-the-wool Tory eurosceptics who, through their intransigence over many years have contributed little or nothing to the welfare of the country but instead have continued to stoke anti-European sentiment and bitterness towards our near neighbours.
The irony of the stance taken by David Cameron and his nasty party is that he has used his Government's veto to safeguard the lack of financial regulation in the City that has led directly to this global calamity. If he does nothing else he now needs to explain to the country just how he intends to curb the greed of these parasites.
I see the Tory right are trying to exploit the euro crisis talks to further their own narrow political agenda. It's like listening to someone arguing about what colour to paint the lounge while the house falls down about their ears.
The decision to not sign up to the latest deal to rescue the eurozone may be defensible but to say it does not isolate Britain, as William Hague did today, is ridiculous.
If 23 countries agree to do something and we do not, then we are isolated. Just admit we are, and say that you think it is the best position for Britain. This "double-speak" is what leads to politicians being held in such contempt.
It appears that we now have a two-speed Europe, with UK being cast aside and clearly on the "outside". But who's in the fast lane? Lane 1 has mild growth, 10 per cent unemployment and high long-term interest rates. Lane 2 has higher growth, lower unemployment and low, stable, long-term interest rates. The future looks a lot rosier for the UK in lane 2 compared to the Eurozone in lane 1. But that's still not as good as lane 3, where growth is modest but unemployment tiny. Switzerland in lane 3 has forged a very prosperous future for itself in Europe despite not being in the EU or adopting the euro.
PR firms live or die by their reputation
Tamasin Cave of the so-called Alliance for Lobbying Transparency criticises me for making a complaint against Bell Pottinger under the PR industry Code of Conduct (Letters, 9 December). She scoffs that the worst sanction against Bell Pottinger is for them to be thrown out of the industry body, the PRCA. I'm not sure what she would have done; perhaps thrown Tim Bell in the Tower.
In fact the worst sanction that falls against PR companies transgressing is the extreme negative publicity that follows a "conviction". PR companies rightly tell their clients that their reputation is one of their most valuable assets, and obviously that applies even more to PR companies themselves. I think Bell Pottinger's reputation has been damaged heavily already. And that will only increase if they are punished by the PRCA. That is the power of self-regulation.
Occupy London is no terror risk
To see the Met equate Occupy London with a terror risk is nothing new (report, 5 December). British citizens exercising their right to protest against American nuclear weapons at Greenham Common in the 1980s were seen as a "Trojan horse" for the Soviet SAS, the Spetsnaz. In fact, in the 1970 and 1980s, government-backed right-wing groups across Europe intimidated and blew up their own people to prove claims of a leftist terror threat, as in the case of the 1980 Bologna train bombing.
Mr Cubbage (letters, 7 December) should count himself lucky he is not a rower. We become eligible for Veteran (also known as Masters) events on the first day of the year in which we have our 27th birthday.
Dr Andrew Ruddle
West Molesey, Surrey
I don't know whether Kenneth Branagh is or is not a veteran actor (Letters, 7 & 8 December). But what I do know is that he is "Belfast-born"; the original article on 5 December mentioned this not once but twice in the same short piece. The article also mentions Ralph Fiennes and Vanessa Redgrave but doesn't tell us where they were born. I think we should be told.
Curb high pay
In Christina Patterson's article on curbing high pay (7 December) she did not make one practical recommendation on how to achieve this. Why not make it law that no government or local authority can pay salaries, or award contracts to any organisation if any individual within it receives in salary, bonus, shares etc, more that 20 times the annual median salary in the UK?
C E Wild
Cleckheaton, West Yorkshire
Guy Keleny ("Errors and omissions", 3 December) objects to "gale-force conditions", but this seems to me to be a suitable (newspaper) contraction for "conditions created by gale force winds".
Ledbury, HerefordshireReuse content