Medical experiments come under greater scrutiny than ordinary medical practice. There are good reasons for such precautions, but this leads to a sort of paradox. As Frederick Mosteller observed
We have a strange double standard now. As long as a physician treats a patient intending to cure, the treatment is admissible. When the object is to find out whether the treatment has value, the physician is immediately subject to many constraints.
If a physician has two treatment options, A and B, he can assign either treatment as long as he believes that one is best. But if he admits that he doesn’t know which is better and says he wants to treat some patients each way in order to get a better idea how they compare, then he has to propose a study and go through a long review processes.
I agree with Mosteller that we have a strange double standard, that a doctor is free to do what he wants as long as he doesn’t try to learn anything. On the other hand, review boards reduce the chances that patients will be asked to participate in ill-conceived experiments by looking for possible conflicts of interest, weaknesses in statistical design, etc. And such precautions are more necessary in experimental medicine than in more routine medicine. Still, there is more uncertainty in medicine than we may like to admit, and the line between “experimental” and “routine” can be fuzzy.
Actually, up to limits of the law (abuse, mistreatment, that sort of thing) you can go ahead and research all you want. If you want to get funding for your experiments, or if you want to publish the results, you do need to follow all guidelines. But if a clinician just wants to satisfy their own curiosity – and the experiment doesn’t violate standards of care – then they can go ahead on their own.
Similarly, as a researcher I could get a pet rat at home, and teach my pet to, say, distinguish jazz and rock. No legal or ethical problem to tech your pet a trick, and the fact that I happen to be a researcher doesn’t enter into it. But the moment I want to use research funding for any aspect of it, or I want to publish the experiment, I’d of course have to get all approvals and other safeguards in place.
Im not certain if you made it apparent already or not, but when a doctor decides on two treatments, his choice is usually for the best without any vested interest in outcome – except to save the patients life.
Unless youre in a capitalist society, in which case doctors often care for their bottom line. Thats rooted in the Hypocritical Oath they all swear to.
But when a doctor has to choose between two treatment options, both of those choices have already past medical scrutiny, and have been found effective in experimentation. He is not wasting time, money, resources, nor is he placing anyone in direct uncertain risk unnecessarily.
There is a huge difference between arbitrarily deciding between two proven methods and handing out potentially risky and absolutely uncertain methods. Especially when the patients themselves decide whether or not to participate in a study, to test something that may or may not work, that may cure them and may just as easily hurt them, to waste time on an uncertainty when they could be getting treated elsewise.
I dont see this as a paradox at all. When you factor in all the variables… in particular the perceptions of the patients (the only true variable that matters, the entire point to medicine), then your so-called paradox is utterly resolved.
“Unless youre in a capitalist society, in which case doctors often care for their bottom line. Thats rooted in the Hypocritical Oath they all swear to.”
Good point. Non-capitalist societies never run into this problem, because nobody bothers to become a doctor.
Mike, I agree that it would be hard to go to the effort of becoming a doctor if you didn’t expect to make much money when you’re done.
“Medicine’s hard. Let’s go shopping!”