Prof. Nathan I. Cherny, MD: Medical Care vs. Medical Research
Prof. Nathan I. Cherny sits down with The Group Room at EMCC 2011. In this segment, Dr. Cherny discusses medical care vs. medical research and how sometimes the individual patient needs are lost at the expense of the research.
The Group Room at the 2011 European Multidisciplinary Cancer Conference was made possible, in part, by:
VIDEO TRANSCRIPT
Selma Schimmel, Founder & CEO, Vital Options International:
This is Selma Schimmel at the Multidisciplinary Cancer Congress 2011 in Stockholm. Today we’re joined by Professor Doctor Nathan Cherny. Professor Cherny is the Norma Levin Chair of Humanistic Medicine at Shaare Zedek Medical Center in Jerusalem. You know as you’re speaking about this it really does bring up the question about clinical trials because yesterday we were in a meeting and you made a few very bold statements that you knew, saying they were controversial, so why don’t we touch on that because there is sort of a parallel track to this.
Prof. Nathan I. Cherny, MBBS, FRACP, FRCP, Dir., Cancer Pain & Palliative Medicine Service, Shaare Zedek Medical Center, Jerusalem:
I’ll prempt my comments by saying the medical research is really important but where we are right now in the standard of care, in the level of cancer care, we’re here because of although the tens of thousands of patients who are prepared to participate in clinical trials sort of helped us to refine a better standard of care. There’s a lot of confusion between medical care and medical research. Medical care is when a doctor works one on one with a patient to design the best care for them, and has the flexibility truly to tie the things to the individual patient. An ill person who chooses to participate in medical research, the goal of that medical research is to provide new, generalizable knowledge. It’s not about providing them individualized care. And this is an important distinction, and it’s an important distinction because number one, many patients are encouraged to participate in the clinical studies, and particularly phase three studies, which are randomized between two options, under the prospect they might be having an option of getting a new and better treatment, which is going to be in their best interest.
What happens to those patients who are randomized to the control arm? Do they feel they have lost out? In many cases they do, in many cases they’ll say ‘if I end up in a control arm that’s it, I’m out of here’. And part of this set’s disappointed is because of this misleading advertising, the research is about getting better care. Sometimes the control arm will turn out to be better than the new arm; sometimes it’ll be the other way around. But the decision to go into the study is misleading for the patient to feel that this is because this is the best thing for them. It may be better for them it may not be better for them. But undoubtedly if they participate the knowledge generated is going to help future patients, and patients further on down the line. They may or may not individually benefit but are they going to be benefiting other people further on down the line? Yes. What I can say is that even the control arm needs to be equivalent to the best standard of available care today.
Selma Schimmel:
Which in the majority of cancer treatments – not supportive care or quality of life type of treatments – but for really hardcore clinical treatment it wouldn’t be less than the standard of care.
Prof. Nathan I. Cherny:
It cannot be less than the standard of care. The requirements of the Declaration of Helsinki are very explicit, extremely explicit about the control arm.
Selma Schimmel:
Professor Doctor Nathan Cherny, I hope we get to do a lot more together with you. Thank you so much.
Prof. Nathan I. Cherny:
It’s a pleasure.
END OF VIDEO