“Ethical double standards”

“Ethics committees (IRBs in the US) are now firmly entrenched in the research environment such that clinical research can only be performed with their approval. Clinical practice, however, is not subject to such approval, yet in many cases the risk of harm (individually and to society) from clinical practice is greater. Are researchers being held to a higher standard than clinicians? Has our concentration on ethical standards for clinical research led to an ethical blind spot for clinical practice?”
“Rightly, the ethics committee has considerable control over research. Their role is to minimise the risk of harm from clinical research. Examples of such harms exist, and these examples (including WWII atrocities) led to the formation of ethical standards for research. However, the committees only have control over what is submitted to them, and they tend not to concern themselves with clinical practice at their institution. For example, the follow up of treated patients (research) needs ethics approval, but clinicians can perform new techniques and implant new prostheses (practice) without ethics approval.”

“Don’t just do something, stand there”
“This reversal of a commonly used phrase is a plea. A plea against the bias that leans doctors towards diagnosing and treating, even when the scientific evidence may not support it. Sure, it is expected that a doctor will diagnose and treat you, but sometimes there is no diagnosis or effective treatment, and pursuing either may be harmful. When in doubt, your doctor will continue to run tests until something comes up, and will continue to treat you for as long as you return with symptoms. Sometimes, not pursuing a diagnosis and not treating a patient are reasonable options. Sometimes they are the best option.”

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