In yesterday's blog post, I wondered why oncologists would neglect -- unintentionally or otherwise -- to tell their patients about a clinical trial that might make a difference in their battle against cancer.

Participating in an experimental drug trial offers patients no guarantees that anything about their condition will change, even a little bit. The only certainties are lofty ones: Providing patients the satisfaction that they may be expanding the current body of medical knowledge about cancer that helps someone else down the road and how effective an experimental drug might be against it, while offering patients some hope, however tiny, that whatever therapy they're doing or taking might make a difference in their own lives.

Today's blog post may explain why oncologists fail to discuss clinical trials with their patients. The problem, as some medical experts see it: Unrealistic optimism or optimism bias, meaning the tendency for patients to be optimistic beyond reality about the outcome of their plans, like fighting cancer with an experimental drug, compared to their peers.

A recent survey conducted by a group of medical ethicists of 72 patients enrolled in early-stage oncology trials in the metropolitan New York area over a 14-month period (2008-09) was telling. Seventy-two percent of patients may have understood the main purpose of these trials was to further knowledge that could help future patients, and not necessarily them, but their responses to three out of five questions revealed unrealistic optimism (they would derive a benefit, be able to control their cancer and suffer no problems from taking an experimental drug, compared to others participating in clinical trials).

Ethicists are concerned that "not all optimism is ethically benign," according to a New York Times interview with lead author Dr. Lynn Jansen. Another expert referred to it as the "Lake Wobegon effect," one in which patients believe they have a better than average chance of benefitting or escaping harm from taking an experimental cancer drug.

Perhaps, the better way to approach any drug trial that may or may not affect your health for the positive is to be a tiny bit hopeful… and very, very realistic about all the possible outcomes.

So, do you believe we're too focused and overly optimistic about THE CURE for our own good? Are hope and optimism overrated? I certainly hope not…

IRB: Ethics & Human Research, Vol. 33, No. 1, p. 1-8, January-February 2011

New York Times March 3, 2011

ScienceDaily January 24, 2011