When recommendations change

The American Academy of Pediatrics released new recommendations today regarding children and car seats. As is often the case with science and medical research, new data emerges and the recommendations that were standard for years can change, seemingly overnight. I make note of this, not because of the change in recommendations, but how personally some parents seem to be taking it. A quick glance of the comments section on New York Times article show parents up in arms about the recommendations, and others chastising those parents for not being concerned enough about their child's safety.

For physicians and nurses who communicate such recommendations to parents, this reaction points to the importance of sensitivity when making recommendations. It is easy for parents to take recommendations as a personal affront to their parenting skills. A little sensitivity and validation of those feelings may go a long way in getting parents to thoughtfully consider a new recommendation.

When a physician is not a physician

The New York Times Well blog is running a series of articles from cancer researcher Dr. Peter Bach. But Dr. Bach is not offering his perspective as a physician or as a researcher, but as the husband of a wife facing breast cancer. It is a unique perspective: objective clinical knowledge and the raw emotion of seeing a loved one in poor health.

This week, Dr. Bach discusses the complexities and emotions of involvement in a clinical trial. It is one thing to objectively understand the reasons for a double-blind study, where a new treatment is compared to standard care. It is another to be the loved one of a patient hoping that your loved one gets the new drug and that it might be just a little better than the standard care. The article, and other that have explored why patients participate in clinical trials, demonstrates that it is perhaps impossible to be totally objective when discussing cancer research. Patients and physicians will always hope that they will be the exception.

More on therapeutic misconception

The ACRP (Association of Clinical Research Professionals) Wire has another article on the important topic of clinical research participation and the therapeutic misconception. It is worth the continued discussion.

Therapeutic misconception and participation in clinical research

In her column this week, Dr. Pauline Chen touches on a serious concern for clinical researchers: therapeutic misconception. Clinical research is dependent on the voluntary, informed participation of research participants. Researchers, coordinators and institutional review boards, put a great deal of time and effort into making sure that potentially participants are fully informed about the nature of their participation in research, including the fact that they themselves may not directly benefit from participating in the trial. But when potential participants face serious, life-threatening illnesses, they may view participation in the trial as their only hope, even if the researcher tells them there is only a small chance they will benefit. Dr. Chen's column ultimately explores the ethics of hope. Is it OK for researchers to enroll participants who are enrolling with unrealistic expectations, despite the researcher's best efforts at informed consent? Is there any way to prevent unrealistic expectations? Should we prevent unrealistic expectations if they give hope?