Controlled clinical trials and clinical patient-care: sometimes in conflict.

BACKGROUND: Pharmaceutical companies can direct scientific agendas and scientific opinion, and their role in sustaining medical research in Canada is considerable. Apart from this, however, the methods of science may come into conflict with patient-care. METHODS AND RESULTS: Using a model of the randomized controlled trial, we describe the types of conflicts that occur between science and patient-care. Such conflicts exist at the level of recruitment, adherence, drop-outs, outcome measures, and toxicity when science clashes with patient-care. These conflicts are illustrated by references to the literature and descriptions of personal experiences. Many of these conflicts are built into study protocols, are potentially avoidable, and are independent of trial sponsorship. CONCLUSION: Those involved in clinical trials must be aware of the conflicts between patient-care and science. When such conflicts occur, patients' needs must take precedence.