Physician as Researcher - Case H4
Eric Overstreet is a fellow in neurology who has just joined a
research team recruiting patients for a double-blinded clinical trial
comparing two drugs in the treatment of multiple sclerosis, a
severely debilitating disease. In anticipation of this project, Eric
thoroughly reviewed previous studies of the properties of these
drugs. His opinion is that drug A has been shown to be superior to
drug B in relatively small trials. The trial now being undertaken
should provide definitive results.
One day, Eric approached a patient to enter the trial. The patient
asked, "Doctor, what do you think of these drugs? Should I enter this
trial?" Eric feels conflicted. Until the trial is over, neither Eric
nor the patient will know which drug he is receiving. As a physician,
Eric believes it is his duty to provide the best therapeutic
treatment possible for his patients, which under other circumstances
would mean giving his patients drug A. As a scientist, however, Eric
understands that his opinions concerning the respective benefits of
these drugs require validation by this larger controlled study.
- Compare and contrast Eric's obligations as both physician and
scientist in this case. Are they in conflict?
- How much credence should Eric give to his personal opinion of
the relative efficacies of the agents?
- How should Eric solicit informed consent in this case? What
information should he provide his patients to be certain that their
consent will be informed?
- Does securing informed consent resolve any concerns you may
have concerning Eric's obligations as a physician?
- What should Eric tell the patient about the drugs if both are
available clinically? What should he tell the patient if only B is
- Assume that this is a pharmaceutical company-sponsored study
and both drugs are currently on the market. Does that situation
raise any special questions?