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29 - Clinical research and the physician–patient relationship: the dual roles of physician and researcher

Published online by Cambridge University Press:  30 October 2009

Nancy M. P. King
Affiliation:
Professor Wake Forest University USA
Larry R. Churchill
Affiliation:
Professor Vanderbilt University, Vanderbilt USA
Peter A. Singer
Affiliation:
University of Toronto
A. M. Viens
Affiliation:
University of Oxford
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Summary

Dr. F, an oncologist in a small community practice, has been asked by a pharmaceutical company to conduct early-phase clinical trials involving several new investigational chemotherapeutic agents that do not yet have FDA approval. These would be very small phase I trials, with the possibility of conducting some phase I/II and phase II trials in the future as well. The reimbursement he will receive for the research will substantially increase the income of his practice, provided that he is able to recruit and retain a sufficient number of subjects. “More importantly, though,” Dr. F thinks to himself, “I have so little to offer many of my sickest patients now. The best thing about doing clinical research is being able to offer them something new, that just might be their best hope.”

Dr. G treats patients with hemophilia. Although treatments have improved dramatically in recent years, hemophilia is a devastating, and devastatingly expensive, chronic disease. Because she has high hopes about promising experimental technologies, she also conducts research. She prides herself on the research partnerships she develops with patient–subjects who seek to contribute to the development of better treatments. Recently, however, she has received inquiries from patients with hemophilia from around the world who want to enroll in her research because the experimental interventions are provided free of charge. These patients tell her that they cannot afford standard therapies, and that enrolling in her research is their only hope for treatment. Dr. G is troubled by this reasoning, and discusses it with a colleague, who responds, “Lots of people enroll in research to get treatment.[…]

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Publisher: Cambridge University Press
Print publication year: 2008

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