It's disheartening to see clinical trials cast as the villain on prime-time television. Last week's episode of Grey's Anatomy delivered a condemnation of both trial randomization and the centuries-old scientific process in the context of today's need for immediate gratification.
The show, seen by 12 million potential clinical trial subjects, involves a male Alzheimer's patient who is a candidate for a clinical trial. He repeatedly asks for his lover during memory lapses, in the presence of his wife and the medical team. "I need my husband back," says the wife, after the couple has agreed that the husband will participate.
The trial investigator, previously puffed up at getting in on "the trial of the century," explains to the disheartened wife that he can't guarantee whether her husband will receive the treatment or placebo. "The computer decides. We don't know until right before we give it."
If it's the placebo, the wife replies, "then change it."
The investigator's angst is palpable. He later declares to a colleague, "I'm off the trial. It's too depressing. I can't do this for the next two years."
This is acceptable TV drama, of course. But the show opens and closes with a voiceover by one of the characters: "Doctors practice deception all the time." Also, "The placebo has to be the doctor's greatest deception.... To half of our patients we tell the truth. The other half, we hope the placebo effect is real."
The wife's reaction is understandable and believable; the investigator's isn't. He is neatly absent of scientific interest and concern for the greater good when he first blames the computer and then resigns from the trial. The show also avoids the process of informed consent, through which the subject would understand about placebo use.
I suppose, however, that any TV drama taking on on the topics of informed consent and trial randomization would probably not reach 12 million viewers. So the masses informed primarily by TV about clinical trials are not only in the dark about their purpose and the role of volunteers, they can now view them negatively. And when members of this public learn that they have a disease and that a treatment in clinical testing offers hope, they also will direct investigators to ensure treatment over placebo.
Thanks, Grey's Anatomy. Now how about an episode based on a trial recruiter who repeatedly encounters these misperceptions, yet is still responsible for signing up some number of volunteers by a certain date?
That's real drama! - George Miller