In the animal kingdom, the vivid plumage of a tropical bird is (for other birds) a reliable indicator of the creature’s health and reproductive vitality.

Likewise, the size and splendor of a trade show exhibitor’s booth is an indicator of the financial health of the company sponsoring it. If elk had trade shows, it would be easy to organize their conventions. Cow elk, as the females are called, would congregate near the bull elks with the biggest antlers.

Our epiphany from the 2007 annual Drug Information Association (DIA) conference in Atlanta this week is that an exhibit hall booth can also be an indicator of the overall maturity of the larger ecosystem in which the organism lives. We’re modestly encouraged, actually.

What A Booth Means

We have been reflecting all week on the etrials booth at this year’s DIA. It was a solid cube with the company’s logo. Atop the cube, encased in glass walls above the convention floor, a male and a female actor cavorted in a mock medical office, making a lovely mess of moving paper around. Lots of it. An embarrassing amount of it.

There were sticky notes. Files. A shredder. A filing cabinet. Piles of files. A wastebasket overflowing with paper. It was chaotic.

Looking In The Mirror

Periodically, the actors would change their costumes, appearing to be Neanderthals or office workers in the 1950s or the 1970s. At the end of the show, on Thursday, the office was finally immaculate and, from what we could tell, efficient.

This hit home on a personal level. It was not funny. In June, our own desk was a shifting paper mess. Mysteriously, over time, the surface of the desk disappeared under a moving dune of newspaper clippings, vital bills, telephone numbers, magazines, printed emails, travel plans, computer manuals, to-do lists, conference brochures, and other documents essential to the operation of ClinPage or what’s left of our personal life.

We finally wrestled the situation under control. It wasn’t easy. It wasn’t fun. A significant percentage of the material was recycled. We still have a milk crate of paper requiring our urgent attention.

A Real Enemy

On some level, paper is the nemesis of clinical trials. It is the enemy of efficiency. As long as doctors and hospitals use paper, it will be a part of how industry collects clinical trial data. The question is whether paper’s importance will ebb over time.

The willingness of etrials to take a risk with humor is, we think, a barometer of a growing sense of dis-ease with the prevalence and burden of paper. Throughout the research process, from electronic lab notebooks through to submissions to regulatory bodies, many vendors are trying to wean the industry from its cellulose addiction. Some sponsors are supporting their efforts. It is impossible to think about the efficiencies of adaptive trials being realized in a paper-infected environment.

Whether in the realm of electronic data capture, electronic patient diaries, electronic document management, paper is sand in the gears of the modern, global trial. The etrials diorama rubbed the industry’s nose in that fact in an amusing way. The industry is the antithesis of the paperless office. Which has profound societal ramifications for both the cost of the research process and the rapidity with which vital clinical data can be analyzed and acted upon.

Turning Point?

“What was most amazing was the number of people who looked up and said, ‘That’s us. We have those same issues,’” says Michael Harte, senior VP of sales at etrials. “Years ago, we couldn’t have gotten away with that. Paper was too engrained in the process.”

Paper is still enshrined in clinical trials. And in our office. But let’s hope the corner has been turned. The speed with which the industry processes its data will be an issue from this point forward. “We’ve always preferred paper” will not be a credible defense when the public or a medical journal editor asks why the results weren’t available sooner.