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Clinical trials as treatment option: Bioethics and health care disparities in substance dependency

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  • Timmermans, Stefan
  • McKay, Tara

Abstract

Bioethicists have warned against the dangers of mixing research with treatment. They are concerned that research priorities may take precedence over individual patient needs and that research subjects tend to misunderstand the purpose of research or overestimate the direct medical benefits of participating in studies. Yet, other work has questioned whether clinical research can always be separated from therapeutic benefit for participants. Using in-depth interviews with participants in two phase III randomized U.S. clinical trials for methamphetamine dependency, we examine the treatment options available to participants, their experiences with participating in the trials, and potential problems of trial participation. We find that while participants have experience with four alternative treatment modalities - quitting alone, support groups, in-patient treatment facilities, and consulting primary care physicians - the randomized clinical trials compare favorably to alternatives because they provide access to evidence-based behavioral treatments, specialized medical professionals, non-judgmental staff, and the possibility of receiving an experimental drug. We conclude that while randomized clinical trials are imperfect substitutes for clinical care, they constitute a fragile and sporadic therapeutic niche in a country with fundamental problems in access to health care, a mixed punitive-therapeutic drug addiction policy, and a profit-driven pharmaceutical development and approval process.

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  • Timmermans, Stefan & McKay, Tara, 2009. "Clinical trials as treatment option: Bioethics and health care disparities in substance dependency," Social Science & Medicine, Elsevier, vol. 69(12), pages 1784-1790, December.
  • Handle: RePEc:eee:socmed:v:69:y:2009:i:12:p:1784-1790
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    References listed on IDEAS

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    1. Cunningham, James K. & Liu, Lon-Mu, 2008. "Impact of methamphetamine precursor chemical legislation, a suppression policy, on the demand for drug treatment," Social Science & Medicine, Elsevier, vol. 66(7), pages 1463-1473, April.
    2. Fisher, Jill A., 2008. "Practicing research ethics: Private-sector physicians & pharmaceutical clinical trials," Social Science & Medicine, Elsevier, vol. 66(12), pages 2495-2505, June.
    3. Sismondo, Sergio, 2008. "How pharmaceutical industry funding affects trial outcomes: Causal structures and responses," Social Science & Medicine, Elsevier, vol. 66(9), pages 1909-1914, May.
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    2. Émilien Schultz & Jeremy K. Ward & Laëtitia Atlani-Duault & Seth M. Holmes & Julien Mancini, 2021. "French Public Familiarity and Attitudes toward Clinical Research during the COVID-19 Pandemic," IJERPH, MDPI, vol. 18(5), pages 1-15, March.
    3. Zvonareva, Olga & Engel, Nora & Martsevich, Sergey & de Wert, Guido & Horstman, Klasien, 2015. "International clinical trials, cardiovascular disease and treatment options in the Russian Federation: Research and treatment in practice," Social Science & Medicine, Elsevier, vol. 128(C), pages 255-262.
    4. Sarradon-Eck, Aline & Sakoyan, Juliette & Desclaux, Alice & Mancini, Julien & Genre, Dominique & Julian-Reynier, Claire, 2012. ""They should take time": Disclosure of clinical trial results as part of a social relationship," Social Science & Medicine, Elsevier, vol. 75(5), pages 873-882.
    5. Shim, Janet K. & Bentz, Michael & Vasquez, Emily & Jeske, Melanie & Saperstein, Aliya & Fullerton, Stephanie M. & Foti, Nicole & McMahon, Caitlin & Lee, Sandra Soo-Jin, 2022. "Strategies of inclusion: The tradeoffs of pursuing “baked in” diversity through place-based recruitment," Social Science & Medicine, Elsevier, vol. 306(C).
    6. Fisher, Jill A. & Cottingham, Marci D. & Kalbaugh, Corey A., 2015. "Peering into the pharmaceutical “pipeline”: Investigational drugs, clinical trials, and industry priorities," Social Science & Medicine, Elsevier, vol. 131(C), pages 322-330.
    7. Lawton, Julia & Jenkins, Nicholas & Darbyshire, Julie & Farmer, Andrew & Holman, Rury & Hallowell, Nina, 2012. "Understanding the outcomes of multi-centre clinical trials: A qualitative study of health professional experiences and views," Social Science & Medicine, Elsevier, vol. 74(4), pages 574-581.
    8. Kingori, Patricia & Gerrets, René, 2016. "Morals, morale and motivations in data fabrication: Medical research fieldworkers views and practices in two Sub-Saharan African contexts," Social Science & Medicine, Elsevier, vol. 166(C), pages 150-159.
    9. Kelly, Ann H. & Ameh, David & Majambere, Silas & Lindsay, Steve & Pinder, Margaret, 2010. "'Like sugar and honey': The embedded ethics of a larval control project in The Gambia," Social Science & Medicine, Elsevier, vol. 70(12), pages 1912-1919, June.

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