Research in Critical Care

So suppose you were in car accident, and had life-threatening injuries... even worse, suppose that it was your kid/spouse. What type of treatment would you want for them???

1. A therapy used "successfully" since the Vietnam War, but without the support of empirically derived evidence. OR
2. A therapy derived from appropriately collected empirical data that has been SHOWN to be more effective

Well obviously, you want #2, the treatment that gives your loved-one the highest probability of survival. What you don't remember though, in that critical moment, are the thousands of patients that that participated in the study that PROVED (knowingly or unknowingly) that the therapy you choose was actually better.

The obvious ethical dilemma that involved the use of humans in medical research is a bad one- but in the end, if we expect the best treatment, we have to live with the thought of the type of research that the Resuscitation Outcomes Consortium is now conducting (covered in the Washington Post May, 26, 2007) which involved the evaluation of alternative resuscitation strategies, largely before obtaining informed consent.

The obvious hot-button issue here is exactly that- no consent. But how do you obtain consent from the dying? Not from their families either, who are at best severely cognitively impaired by acute emotional shock... Even if not, the delay caused by attempting to get consent seals the deal. In shock, minutes are literally the difference between life and death.

Now these new therapies, while experimental, are very likely to be just as good or better than conventional strategies. They have been through and passed every other level of analysis. The researchers HAVE to say that they could be worse than conventional strategies, but if the evidence had suggested this- why would they be doing it? Researchers have pride (often times too much), and nobody wants to be the PI of a research project that fails and kills people doing it...

People get over it!! Yes, obviously informed consent is great, and is integral to the practice of medicine, but informed consent does not rise to the level of the categorical imperative... Get it when you can, save the patients life without consent if you have to... And remember, if what you want is optimal medical therapy, you have to accept that sub-optimal treatments existed in the past, and were labeled so after experiments (necessarily on human beings)showed that to be the case..

Not surprisingly, there are many people who are interested in reaping the benefits of research, but refuse to pay the cost, here, here, here, here, and most awfully here- but see good guys here,