Surgeons and scientists may have reached a breakthrough with glioblastoma, a malignant brain tumor (the same as the one that killed Senator Edward Kennedy), and according to Dr. Russell Lonser of NIH “one of the most deadly tumors that exist in humans.” Although still in the trial stage, neurosurgeons have found a way to directly release a cancer drug into the brain and onto these malignant tumors. Using microcatheters, doctors can bypass the blood-brain barrier and release the chemotherapy to directly target the tumors. However, this was a dangerous experiment, as the drug, called Avastin, could have caused swelling in the brain, a hemorrhage, or a seizure.
In an article by the New York Times, Dennis Sugrue was featured as the second person to have had Avastin injected directly into his brain. Despite the dangers of the experimental drug, he agreed to go through with the clinical trial, which has so far been successful. But despite the success and positive direction of the trial currently, there was much more to his decision to participate in the trial. As columnist Denis Grady writes, doctors must “balance their ambition as researchers against their duty as clinicians, and must walk a fine line between offering too much hope and not enough.” Also, according to the guidelines drafted in the Belmont Report, doctors must provide their patients with enough information to allow them to make in informed decision. However, in the actual report, this is all a little vague—how much information is enough? Dr. Boockvar, Dennis Sugrue’s surgeon, answers this question for us: “In neurosurgery they say that if you don’t make your patient cry, you haven’t gotten informed consent.”
After reading this quotation, I began to think about the duty that doctors (neurosurgeons in this case) have to their patients undergoing trials. Just as Grady writes, they must realize that they must protect their patients in addition to aspiring to find the next cure. It may be hard to be completely truthful when on the brink of a huge breakthrough such as a cure for cancer, but doctors must provide their patients with all the information they have. And in neurosurgery, it will be enough to make them cry.
Articles Relevant to my Post:
http://www.nytimes.com/2009/11/17/health/17tumor.html?pagewanted=2&_r=1&ref=health
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The Downside of Informed Consent
In this article, you bring up the issue of informed consent. How much information must the doctor provide to the patient for the patient’s decision to be considered informed? Should the doctor’s own opinion have any weight in the decision?
The medical community has grappled with this second question as the issue of informed consent has increasingly entered the public consciousness and medical lawsuits become an ever increasing threat to doctors. Should doctors be able to give their opinion about what they believe to be the correct treatment? Many doctors fear to do this, afraid that if the results are no optimal they will be sued for giving the “wrong” opinion. However, in fact, it may be that patients actually really value the doctor’s opinion. A study published in 2005 by a group of medical doctors and professors found that over half of the patients they interviewed valued their doctor’s opinion most in making their decision regarding their treatment.
I can imagine feeling overwhelmed by the “full” body of information. With many different treatment options to choose from, all with their own unique pros and cons, it would be difficult to choose which option is best, unless one option clearly seems better than the others. In this case, I would want to know from the doctor what she believes is best. However, another issue arises from the fact that patients these days are often encouraged to get a second opinion. What is the second doctor paints a different picture? It is inevitable that the two doctors may have different preferences for different treatments. In the end, while I believe that informed consent is necessary, I also think that it may have the potential to confuse and overwhelm the patient. What is the right balance?
Mazur, Dennis J., et al. “The Role of Doctor’s Opinion in Shared Decision Making.” Health Expectations. 8, no. 2 (2005). 18 Nov. 2009.
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