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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.

Questions:

  1. Compare and contrast Eric's obligations as both physician and scientist in this case. Are they in conflict?
  2. How much credence should Eric give to his personal opinion of the relative efficacies of the agents?
  3. 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?
  4. Does securing informed consent resolve any concerns you may have concerning Eric's obligations as a physician?
  5. What should Eric tell the patient about the drugs if both are available clinically? What should he tell the patient if only B is available clinically?
  6. Assume that this is a pharmaceutical company-sponsored study and both drugs are currently on the market. Does that situation raise any special questions?
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