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We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com. Back to Healio Key takeaways: Experts say prediction markets could hurt trials\u2019 equipoise and validity. Clinicians should be prepared to answer patients\u2019 questions about probabilities tied to trials on marketplaces. Prediction marketplaces are taking their first steps into the pharmaceutical field \u2014 a move that some experts say may threaten the integrity of clinical trials. Prediction markets are platforms where users buy and sell shares on the future outcomes of events across a variety of subjects, like entertainment, sports, politics and technology.
Prediction marketplaces like Polymarket could adversely impact trials\u2019 validity and participation. Image: Adobe Stock
According to Matthew Vogel, MBA, a professor of health policy at Brown University, and colleagues, online prediction markets like Kalshi and Polymarket are introducing betting on drug development outcomes such as \u201cwhether POLARIS-AD, a phase 3 trial of the experimental Alzheimer\u2019s drug AR1001, will meet its primary endpoint.\u201d Kalshi in particular has \u201ccontracts on endpoints in large, late-stage trials but is considering broadening its scope to include earlier-phase trials and additional outcomes, such as the number of reported adverse events for a drug,\u201d Vogel and colleagues wrote in a perspective in The New England Journal of Medicine. Prediction marketplaces are seeing rapid growth, generating $50 billion in trading in 2025, according to the authors. \u201cIt\u2019s an unknown territory,\u201d Vogel told Healio. \u201cWe\u2019ve never had anything like it before.\u201d Concerns about prediction markets Vogel said there is real concern about how prediction markets could affect the processes and results of clinical trials. One worry, of course, is the manipulation of trials in order to profit. The stakes of betting on a clinical trial are much higher than those of football games or daily temperatures, Vogel said, as participants and researchers may influence trial results by changing their behavior based on the odds. \u201cYou want to have real equipoise for a clinical trial, and also perceived equipoise,\u201d he said. For example, high or low probabilities early in a trial could affect perceptions of whether a treatment will work, potentially drawing people toward some trials and away from others. The amount of information in a market, which influences the accuracy of probabilities, can play a role as well. \u201cIf you have a market that\u2019s trading on good information, where there\u2019s a lot of liquidity, the price is going to be more accurate,\u201d he said. For a clinical trial, Vogel cautioned that people with limited knowledge on the drug or intervention could influence public predictions, which patients may encounter online when deciding whether to join a trial. Thus, clinicians may need to explain to patients why probabilities \u201cshouldn\u2019t be mistaken for an individual patient\u2019s likelihood of having a response to a drug,\u201d Vogel and colleagues wrote. Although accurate probabilities could potentially speed the development of effective drugs \u201cand redirect resources away\u201d from unsuccessful drugs, inaccurate predictions could mislead patients and affect trial participation, adherence, dropouts and crossovers, Vogel said. Prices are not scientific measures Vogel said prediction-market prices reflect what traders are willing to pay based on their knowledge and expectations in the moment. Although these prices can be interpreted as probabilities, \u201cit\u2019s important to understand these are not a scientific measure,\u201d he said. Prediction markets have historically performed well, Vogel added, but their accuracy must be evaluated against other forecasting methods. \u201cThese markets will not necessarily be right,\u201d he said. \u201cAt best, the strongest claim you can make about them is that they will be more accurate than the next best alternative.\u201d To address concerns about how betting can influence clinical trials, Vogel and colleagues said regulators, including the U.S. Commodity Futures Trading Commission and the FDA, could establish a \u201ctransparent rulemaking process focused on risks to clinical trial integrity.\u201d \u201cClinical trial contracts should be reviewed individually by regulators before being traded on betting platforms,\u201d they wrote. \u201cFor each trial, platforms could be required to identify all people with access to nonpublic information about the trial and prevent them from trading.\u201d The authors also recommended restricting betting on small trials, \u201cin which trading could more readily influence trial-related conduct or outcomes.\u201d \u201cIn addition, contracts shouldn\u2019t be tied to measures that are easy to manipulate,\u201d they wrote. \u201cFor example, Kalshi\u2019s proposal to allow users to bet on whether a certain number of drug-specific reports are made to the FDA\u2019s Adverse Event Monitoring System is problematic, since anyone can submit such a report.\u201d For more information: Matthew Vogel, MBA, can be reached at primarycare@healio.com. Ask a clinical question and tap into Healio AI’s knowledge base.
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