Clinical research and clinical care: ethical problems in the "war on cancer"

Recent discussions in the public press had multiple overtones indicating that there are major ethical problems in the "war on cancer", especially in pediatric oncology. Several factors have contributed to the current dilemma: the quest for a cure by society, and the patient's hope to be cured, are often not compatible; research has become a mode of care at the expense of compromising scientific rigor; and a generation of new oncologists--who do not understand the basic precepts of science--has begun practice. Uncertainty of outcome is an unavoidable consequence of prospective randomized trials, forcing patients to rely totally on the objective tools of medicine. This destroys a major principle of medicine, namely that patient and doctor alike must have faith in the method of care, in the outcome, and in each other. It is nearly impossible to be a healer and a researcher without encountering major ethical conflicts. When the separateness of care and research are again recognized, the inherent ethical absurdity that is now unknowingly espoused will no longer be perpetuated.