Well informed uncertainties about the effects of treatment
http://www.100md.com
《英国医生杂志》
EDITOR—As inevitable and unpleasant as many uncertainties are, one can argue that patients (and their doctors) should not even strive to completely eliminate uncertainties. Although the role of scientific method is to reduce uncertainties, a total elimination of uncertainty would be undesirable, since, it has been argued, it would lead to deterministic life—meaning that all events would be known in advance, in turn implying no hope, no ethics, no freedom of choice.1
Hence, there is a paradox in dealing with uncertainty—we want to reduce uncertainty, but we do not want to eliminate it totally.1 Only because we do not know what the future holds can we have our hope and choices.1 In the context of informing patients about the effects of treatments, this means that the patients' basic right is whether to accept that uncertainty2 exists (which in practice often means disagreement among their doctors), and the proposed method for resolution of the existing uncertainties (which can include enrolment into a clinical trial as one of the means to resolve uncertainties).3-5
Therefore, uncertainty should not be looked on as the enemy but rather as a friend (or as the opportunity). Once uncertainty is recognised and acknowledged,2-5 more effective solutions for its resolution can be devised. Hence, "two cheers for uncertainty."1
Benjamin Djulbegovic, professor of oncology and medicine
H Lee Moffitt Cancer Center and Research Institute, University of South Florida 12902 Magnolia Drive, Tampa, FL 33612, USA djulbebm@moffitt.usf.edu
Competing interests: None declared.
References
Hastie R, Dawes RM. Rational choice in an uncertain world. London: Sage Publications, 2001.
Djulbegovic B, Clarke M. Informing patients about uncertainty in clinical trials. JAMA 2001;285: 2713-4.
Silverman WA, Chalmers I. Casting and drawing lots: a time-honoured way of dealing with uncertainty and for ensuring fairness. BMJ 2001;323: 1467-8.
Djulbegovic B. Acknowledgment of uncertainty: a fundamental means to ensure scientific and ethical validity in clinical research. Curr Oncol Rep 2001;3: 389-95.
Chalmers I. Well informed uncertainties about the effects of treatments. BMJ 2004;328: 475-6. (28 February.)
Hence, there is a paradox in dealing with uncertainty—we want to reduce uncertainty, but we do not want to eliminate it totally.1 Only because we do not know what the future holds can we have our hope and choices.1 In the context of informing patients about the effects of treatments, this means that the patients' basic right is whether to accept that uncertainty2 exists (which in practice often means disagreement among their doctors), and the proposed method for resolution of the existing uncertainties (which can include enrolment into a clinical trial as one of the means to resolve uncertainties).3-5
Therefore, uncertainty should not be looked on as the enemy but rather as a friend (or as the opportunity). Once uncertainty is recognised and acknowledged,2-5 more effective solutions for its resolution can be devised. Hence, "two cheers for uncertainty."1
Benjamin Djulbegovic, professor of oncology and medicine
H Lee Moffitt Cancer Center and Research Institute, University of South Florida 12902 Magnolia Drive, Tampa, FL 33612, USA djulbebm@moffitt.usf.edu
Competing interests: None declared.
References
Hastie R, Dawes RM. Rational choice in an uncertain world. London: Sage Publications, 2001.
Djulbegovic B, Clarke M. Informing patients about uncertainty in clinical trials. JAMA 2001;285: 2713-4.
Silverman WA, Chalmers I. Casting and drawing lots: a time-honoured way of dealing with uncertainty and for ensuring fairness. BMJ 2001;323: 1467-8.
Djulbegovic B. Acknowledgment of uncertainty: a fundamental means to ensure scientific and ethical validity in clinical research. Curr Oncol Rep 2001;3: 389-95.
Chalmers I. Well informed uncertainties about the effects of treatments. BMJ 2004;328: 475-6. (28 February.)