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A tale of science, war and cider

Posted on 22 May, 2013 by Louise Dean

Citrus fruit 

A new campaign, ‘Ok to ask’, was launched this week by the National Institute for Health Research, with the aim of empowering patients to ask their doctors about clinical research opportunities.

It’s a subject close to our heart here at The Institute of Cancer Research, London, because clinical trials are an important part of what we do – and encouraging patients to take part is critical to testing out and eventually making available new treatments for cancer patients.

Abiraterone is just the latest of a series of drugs to be made available on the NHS after undergoing clinical trials at The Institute of Cancer Research (ICR) and The Royal Marsden.

‘OK to ask’ is hooked around International Clinical Trials Day, which commemorates the anniversary of the very first clinical trial by James Lind. So it seemed as good a time as any to delve around and see what I could find out about this first clinical trial.

It’s the middle of the 18th Century and sailors can now navigate for long periods of time out of sight of land. But this means that sailors are away from land for many months, crammed into small boats at the mercy of the sea. Without access to fresh food supplies, sailors became ravaged by nutrient deficiencies.

We now know that deficiency in vitamin C causes scurvy, but back then it was thought that scurvy was a result of putrefaction of the body.

Our hero of this tale, James Lind, served as a Royal Navy surgeon aboard the ship-of-war HMS Salisbury. Salisbury and her crew spent weeks patrolling the Bay of Biscay and, during a 10-week absence from shore, 80 out of 350 sailors were struck down by scurvy.

At the time, acids were used to try to treat scurvy – with limited success, I would imagine. On 20 May 1747 aboard HMS Salisbury, James Lind commenced the world’s first controlled clinical trial.

Lind divided 12 scorbutic sailors into six groups. All the patients received the same diet but, in addition, group one was given a daily quart of cider, group two received 25 drops of elixir of vitriol (sulphuric acid), group three received six spoonfuls of vinegar, group four, half a pint of seawater, group five were given two oranges and one lemon, and the sixth group, a spicy purgative mixture plus a drink of barley water. I don’t particularly relish the idea of receiving the treatment administered to groups two, three, four and six. Treatment of the group receiving oranges ended after six days when Lind ran out of fruit, but already one sailor was fit for duty while the other had almost recovered.

Lind's experiment made history because it was the first clinical trial to include control groups. Unfortunately his findings were not immediately accepted and not acted upon until over 40 years later, when the Admiralty ruled that all sailors would have citrus fruits included in their diets. This is why English sailors where nicknamed ‘limeys’. Within a few decades the Royal Navy largely eliminated the disease from their ships.

Today’s clinical trials have moved on leaps and bounds and are now highly regulated. They are an essential step in establishing new and effective treatments for patients.

At the ICR, our clinical trial unit has National Cancer Research Institute (NCRI) accreditation, which recognises our professional specialism within cancer research. We have a diverse portfolio of clinical trials, each aimed at evaluating the safety and efficacy of novel cancer therapies and delivering answers to inform practice for future patients.

The NIHR’s campaign is extremely valuable and we encourage patients to explore the opportunity of participating in a clinical trial.


James Lind Royal Marsden NHS Foundation Trust
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