Community Views on Neurologic Emergency Treatment Trials Ann Emerg Med. 2011;57:346-354

30 May

I kind of have an interesting side-line/rant on the role/status that doctors play in culture/society. People like us, respect us, and defer to us. Even if not individually (for example when the sue us as individuals) then at least corporately. The medical profession as a whole is perhaps our last great hope for humanity.

I admit I got a bit hyperbolic on the last bit there to make the point but I find it interesting. Buy me a pint and I’ll talk your ear off about it.

Anyhow.

This is a fascinating paper that tells us lots about research but also about what communities think about a lot of what we do.

There is a tremendously strong image that what we do works. And not even just the specifics of what we do, even if we do anything they think it’s good. They call this “the therapuetic misconsception” in the paper.

The impression that the experimental treatment was better than nothing was universal in all the focus groups. People were angry that someone might get randomised to placebo seeing this as unfair

good quote from the authors:

Clinical equipoise and the presence of the therapeutic misconception played heavily into participants’ responses. Despite repeated attempts by the facilitator to reinforce the concept of experimentation, participants continued to assert that the study medication would be beneficial

And this despite the history of medical research being quite the opposite. We try lots of things, most don’t work.

There’s also some great bits where people were angry that their position in the trial was randomly decided by a computer algorithm. This says something quite profound about how deeply we’re attached to the illusion of control that we live under. Quoting one of focus groups:

If you feel like you’ve seen a better result in your patients using treatment A or treatment B, and you feel that that would benefit me to use treatment A or treatment B, I’m going to put my trust in you and not in the lottery. I’m going to say give me the treatment that you feel more comfortable with or that you would trust

Also some interesting (and perhaps not entirely complementary) opinions on paramedics

I also don’t know if I would trust the EMTs over a doctor. They’re not quite as qualified. I don’t know if they’d be able to assess the situation well.

There may be a reason in any given situation to trust a certain doctor over a certain paramedic but to trust them simply because they’re a doctor is interesting in itself

The faith in science, and particular in doctors, the faith that we will do the right thing is pretty overwheming. As medics and researchers we would do well to be aware how fragile this trust is and learn how to communicate a little more honestly and a hell of a lot more humbly

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