aaron lee

the life of a medical student
therapuetic misconceptions
Filed under Med School Life

Therapeutic misconception can be defined as the misunderstanding of the research subject of the potential therapeutic outcome in a study, stemming from mismatched expectations. The situation commonly arises and is best illustrated in placebo-controlled randomized controlled trials (RCTs) where the patient has a significant chance of being in the placebo control group and not in the experimental therapy group, but the patient believes that he or she will benefit by being in the study by receiving the experimental therapy. This misunderstanding, in part, stems from the unconscious entitlement that comes from the patient agreeing to be a part of a scientific study, and in volunteering their well-being, health, and time, they unconsciously believe that they should benefit from being in the study. While a gift may substitute for some of this unconscious entitlement since they are receiving something for their time and effort, nonetheless therapeutic misconception remains a problem in clinical trials. One evidence of this is the attention that is spent on controlling for the placebo-effect in the placebo group, while little or no effort is spent on controlling for placebo-anticipation in the experimental group.

In looking at whether it should be avoided, one must look at both the short-term and long-term consequences of therapeutic misconceptions. From a health standpoint, since IRBs institute ethical standards about equivalency of the therapies of the arms of an RCT, theoretically there should not be a concern as to the objective health concerns of therapeutic misconceptions. Instead, there is less tangible damage done with the mismatching of expectations at the end of the study during debriefing or even during the study when the patient expects to be receiving the experimental therapy. From this mismatching, the patient-researcher relationship is irrevocably damaged, and indeed the patient’s trust of the medical system as a whole may be marred as well. The future impact and consequences of this damage are impossible to assess yet they may translate to true harm to patients’ health when mistrust interferes with medical decision points. From a societal perspective, these intangible damages may translate to a gradual animosity against the medical community.

While there may appear to be few short-term consequences of therapeutic misconceptions, there truly are long-term consequences. These consequences give little incentive for the researcher to attempt to protect against therapeutic misconceptions and take additional measures to protect against them. Yet they must be avoided at all costs since the consequences are sufficiently harmful.

Posted by aaron on Sunday, February 3rd, 2008


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