Many individuals in the field are frustrated by the slow progress getting PDT established in mainstream clinical practice.
The five key reasons are:
1. Lack of adequate evidence of safety and efficacy and optimization of dosimetry. These are fundamental. The
number of randomized controlled studies is still small. For some cancer applications, it is difficult to get
patients to agree to be randomised, so different approaches must be taken. Anecdotal results are not acceptable
to sceptics and regulators.
2. The regulatory processes. The rules get more complex every day, but there is no choice, they must be met. The
full bureaucratic strength of the pharmaceutical industry is needed to address these issues.
3. Conservatism of the medical profession. Established physicians are reluctant to change practice, especially if it
means referring patients to different specialists.
4. Lack of education. It is amazing how few physicians have even heard of PDT and many that have, are
sceptical. The profile of PDT to both the medical profession and the general public needs to be raised
dramatically. Patient demand works wonders!
5. Money. Major investment is required to run clinical trials. Pharmaceutical companies may see PDT as a threat
(eg reduced market for chemotherapy agents). Licensed photosensitisers are expensive. Why not reduce the
price initially, to get the technique established and stimulate demand? PDT has the potential for enormous cost
savings for health service providers.
With appropriate motivation and resources these problems can be addressed. Possible routes forward will be suggested.