I have always felt that issues should be judged by the context of their times. For some issues, however, context provides no justification. Thankfully, the field of medical ethics has evolved into a robust discipline, and there is an enormous need for it. I have read defenses of prior ethical lapses, and even some recent ones, suggesting that context matters.
If a three-month, placebo-controlled study is conducted in the developing world testing a medicine that was highly effective against a serious illness, are the ethical dimensions considered and respected? Were the pharma companies choosing this study locale as a cheap test run for their drug, which will ultimately be marketed in the west? Is it ethically problematic not to provide additional medications to ill subjects after the 3 month trial ends? Can we be assured that a rigorous informed consent process was followed? Sadly, outrageous practices have been reported in the very recent past.
Our president and secretary of state recently and rightfully apologized to Guatemala for American experiments performed there in the 1940s when patients were intentionally infected with syphilis. These patients were mentally ill. While I can concoct a distorted and tortured rationale that would justify this reprehensible practice, such reasoning passes no threshold of decency. Some behaviors and practices are always wrong, in any context. Read more »
JoPM, Oct 21, 2009: “….most of what appears in peer-reviewed journals is scientifically weak.”
The Atlantic, Oct. 16, 2010: “Much of what medical researchers conclude in their studies is misleading, exaggerated, or flat-out wrong.”
JoPM 2009: “Yet peer review remains sacred, worshiped by scientists and central to the processes of science — awarding grants, publishing, and dishing out prizes.”
The Atlantic 2010: “So why are doctors — to a striking extent — still drawing upon misinformation in their everyday practice?”
Dr. Marcia Angell said something just as damning in December 2008 in the New York Review of Books: “It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor of The New England Journal of Medicine.” (Our post on Angell is here.)
What’s an e-patient to do? How are patients supposed to research if, as all three authorities say, much of what they read is scientifically weak? Read more »
Reporting from the American Society of Clinical Oncology conference in Chicago, empowered patient Andrew Schorr discusses how long it can take before a study is presented at ASCO and the role of clinical trials in giving patients access to the medicines of tomorrow today.
“…I have always depended on the kindness of strangers.” — Blanche DuBois in Tennessee Williams’ play A Streetcar Named Desire
Years ago when I began my medical training, I recall enrolling patients for clinical research. In cardiology, there were a myriad of questions that needed to be answered, especially in the area of defining which medications were best to limit the damage caused by a heart attack.
Patients routinely participated in large, multi-center prospective randomized trials to answer these questions. It was routine for them not to charged for participating in the trial — the drug(s) and additional testing would be funded by the company whose drug was being studied. Patients enrolled willingly, eager to help advance science and perhaps, in some small way, their fellow man. It never dawned on me in those early days why hospitals and research centers were so eager to promote research. Read more »
*This blog post was originally published at Dr. Wes*
Here’s the first of many posts from Internal Medicine 2010 in lovely Toronto, Canada.
As you’d expect during a cardiology lecture, Steve Kopecky, FACP, reviewed lots of studies known by cool acronyms. He also explained why picking an inspiring name like “COURAGE” is important for your trial, based on his attempt to recruit a patient for the “BARI” trial:
“Oh no, doc, you ain’t gonna bury me,” the patient replied.
Because that joke was funny, I’ll forgive Dr. Kopecky the implied insult with which he began his lecture:
“The Wall Street Journal’s become one of the best medical journals you can read.” (Harumph.)
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