EXAMPLE 7 Are subjects treated too well?

Surely medical experiments are realistic? After all, the subjects are real patients in real hospitals really being treated for real illnesses.

Even here, there are some questions. Patients participating in medical trials get better medical care than most other patients, even if they are in the placebo group. Their doctors are specialists doing research on their specific ailment. They are watched more carefully than other patients. They are more likely to take their pills regularly because they are constantly reminded to do so. Providing “equal treatment for all” except for the experimental and control therapies translates into “provide the best possible medical care for all.” The result: ordinary patients may not do as well as the clinical trial subjects when the new therapy comes into general use. It’s likely that a therapy that beats a placebo in a clinical trial will beat it in ordinary medical care, but “cure rates” or other measures of success estimated from the trial may be optimistic.