Traditionally, clinical trials have been understood as continuouswith clinical medicine.1 In providing medical care for patients,the physician makes observations, investigates, tests hypotheses,and experiments with different treatments. Moreover, the exemplaryphysician is always learning how to improve treatment for futurepatients on the basis of clinical experience with current patientsand familiarity with the medical literature. Chalmers summarizedthis view as follows: "The practice of medicine is in effectthe conduct of clinical research . . . . Every practicing physicianconducts clinical trials daily as he is seeing patients. Theresearch discipline known as the `clinical trial' . . . [Full Text of this Article]
Differentiating Clinical Trials from Medical Care
Clinical Trials and the Physician–Patient Relationship
Ethical Problems with the Therapeutic Orientation to Clinical Trials
Overcoming the Therapeutic Orientation
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From the Department of Clinical Bioethics (F.G.M.) and the Psychiatry Consultation Liaison Service (D.L.R.), National Institutes of Health, Bethesda, Md.
Address reprint requests to Dr. Miller at the Department of Clinical Bioethics, Clinical Center, National Institutes of Health, Bldg. 10, Rm. 1C118, Bethesda, MD 20892-1156, or at fmiller@nih.gov.
Related Letters:
Protection of Research Subjects
Kaufman J. L., Bateman B. T., Meyers P. M., Schumacher H. C., Berger J. T., Karlawish J. H.T., Campbell D. J., Karnad A., Sudbo J., Miller F. G., Rosenstein D. L., Tremaine W. J., Noble J. H. Jr., Sharav V. H., Pesando J. M., Drazen J. M.
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N Engl J Med 2003;
349:188-192, Jul 10, 2003.
Correspondence
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