You may ask what physician ethics (moral principles that govern a person’s behavior or the conducting of an activity) and the scientific method (a method of inquiry based on empirical or measurable evidence subject to specific principles of reasoning) have to do with each other. Let me explain.
The scientific method was developed in the 1700’s. It is the basis for what is considered good and valid scientific and medical research. Your physician’s medical knowledge is based on millions and even billions of experiments on organisms, animals and humans since the 1700’s. Many experiments since the 1700’s have dis-proven previous experiments because better testing methods have been developed. Or, perhaps, better tools to measure the result or effect of an experiment are now used which has changed the findings of previous experiments.
One element often used in scientific research is the double-blind experiment. How are double-blind experiments performed and what are their purpose? An Internet search engine explanation tells us:
“Double-blind methods can be applied to any scientific experimental situation in which there is a possibility that the results will be affected by conscious or unconscious bias on the part of researchers, participants, or both. For example, in animal studies, both the carer of the animals (or humans) and the assessor of the results have to be blinded; otherwise the carer might treat control subjects differently and alter the results.”
Double-blind experiments are considered the gold-standard in scientific experiments. There is little opportunity for those conducting the experiment and those in the experiment to influence the results.
Physicians currently prevent their treatment decisions from being “blind”. How you ask? Well, let’s look at the information we already know. Since we are discussing cancer, let’s look at physician oncologists and the drugs they use in chemotherapy to treat patients. Being the carer (care-giver) of their patients (as is mentioned above), you might think they attempt to rigorously apply not only scientific knowledge but also scientific methods to patient care.
If you have ever had chemotherapy, like I have, you know that you are weighed before every treatment. Your oncologist must know your exact weight today, so that he or she knows exactly how much of the drug to give you. You are given other drugs like Benadryl or another drug to prevent any side effects of the chemo drugs. The drugs to counteract the side effects of chemo are based on the scientific evidence learned in the clinical trials. The trials are rigorously performed before the drug was approved by the FDA (U.S. Food and Drug Administration) in the US. Or if you are not a US citizen, they will have been similarly tested and approved by your country’s regulatory body. The drug manufacturer who performed these trials distributes information on the drug’s use and manner it is best used.
What Are the Non-Medical Influences in Treatment Decisions?
So how does your physician choose the chemotherapy drug best for you? Do physicians use their 7+ years of medical training in the scientific method? Is the decision based solely on the patient’s needs and scientific research. Well, perhaps it is but there are some additional factors that can easily creep into the decision because the decision is anything but double-blind for the physician.
As mentioned in the Intro and FAQs section of this website, in 2006 a NBC News video and article Cancer Docs Profit From Chemotherapy Drugs reported that there is an influence on the oncologist’s chemotherapy choice for a patient. It is a factor that would never be allowed in the scientific method when conducting research. Dr. Robert Pearl, M.D. also tells us in his 2014 article, Are Oncologists Recommending The Best Treatments For Patients? nothing has changed eight years later since the NBC News 2006 video. In fact, you have every reason to also doubt the clinical trials by Big Pharmaceutical companies providing the chemotherapy and how rigorously they are conducted after reading, Memorial Sloan Kettering Doctors’ Stance on the High Cost of Cancer Drugs Featured on 60 Minutes. It seems the physicians involved in original chemotherapy research conducted by the Drug Company are not always as scientific as we expect. Nor is the research always as “double-blind” as it needs to be.
Do physician oncologists want to demonstrate their chemotherapy treatment decisions are ethical and are made solely in the best interest of the patient? If so, they will conduct an experiment where they are not aware of the revenue streams of their personal income or the income of the hospital. This experiment is not difficult to set up, given how many physician groups are now owned by hospitals. And, after 2-5 years, when the research is completed, the income held in escrow they did not receive during that time could be distributed. (P.S. Any physician groups interested in doing this can email me. It will cost nothing.)
It’s Time for Research into Physician Ethics and Treatment Decisions
For now, it seems now that the three news stories show a hypothesis that physician oncologists are currently ethically challenged. The distribution and use of these drugs is done in a way that is not based on the scientific method. Drugs are not chosen based on the need to control healthcare expenditures. And, considering the patient’s interests may be a factor in treatment decisions but it does not seem to be first, as the anecdotal evidence currently shows.
Anecdotal evidence is unscientific. So, I’m at a loss as to why the medical community in the U.S. continues to operate this way. Physicians are the first to dismiss conversations when a patient brings up herbal remedies for cancer support or treatment. They dismiss any “evidence” as anecdotal. Why don’t physicians discount their own anecdotal behavior in the same way? They imagine anecdotally they are not influenced by tens of thousands of dollars they receive prescribing “this vs. that” chemotherapy in their practice? Let’s prove they are not. Currently, it appears they are.
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