The Therapeutic Misconception at 25: Treatment, Research, and Confusion

  title={The Therapeutic Misconception at 25: Treatment, Research, and Confusion},
  author={Jonathan Kimmelman},
  journal={Hastings Center Report},
  pages={36 - 42}
  • J. Kimmelman
  • Published 12 November 2007
  • Psychology
  • Hastings Center Report
"Therapeutic misconception" has been misconstrued, and some of the newer, mistaken interpretations are troublesome. They exaggerate the distinction between research and treatment, revealing problems in the foundations of research ethics and possibly weakening informed consent. 
An approach to evaluating the therapeutic misconception.
A report proposes a defi nition that does not refer to anything "therapeutic" and says that the therapeutic misconcep tion occurs when individuals fail to understand that they are under a therapeutic misconception.
Eschewing definitions of the therapeutic misconception: a family resemblance analysis.
  • D. Goldberg
  • Psychology
    The Journal of medicine and philosophy
  • 2011
The paper addresses the social and cultural factors that seem to animate the TM among subjects and adopts a Wittgensteinian approach to evaluating the TM, suggesting that interlocutors do not need any analytic definition of the TM to use the term meaningfully in thinking about the moral implications of theTM in practice.
Presuming Patient Autonomy in the Face of Therapeutic Misconception
This article argues that the mere expression of aspects of therapeutic misconception should not necessarily displace the presumption of subject autonomy or undermine ethical inclusion in research for at least three reasons.
Reassessing the measurement and presence of therapeutic misconception in a phase 1 setting
A lower TM estimate in the phase 1 setting than previously found in a similar cohort is reported, threatening valid informed consent to participate in clinical trials.
Therapeutic misconceptions and misestimations in oncology: a clinical trial nurse's guide.
  • Jennifer Scott
  • Medicine, Psychology
    Clinical journal of oncology nursing
  • 2013
This article will define therapeutic misconceptions and misestimations, explore contributing factors, and explain how they can be prevented by clinical trial nurses.
Why is therapeutic misconception so prevalent?
It is suggested that reducing TM requires encouraging subjects to adjust their frame, not just add information to their existing frame, and what is necessary is a scientific reframing of participation in a clinical trial.
Beyond the ‘therapeutic misconception’: Research, care and moral friction
It is argued that the objectives of health care and research often merge in mutually constitutive practices and the presentation of the research-care tension as an ethical dilemma is misleading and even part of the problem that must be dealt with by those involved.
Clinical research in context: reexamining the distinction between research and practice.
This analysis shows that, from an epistemological point of view, clinical research and clinical practice are not sharply distinct but intimately intertwined, which has profound implications for the ethics of human subjects research.
The “Research Misconception” and the SUPPORT Trial: Toward Evidence-Based Consensus
In the SUPPORT trial and similar CER or standard of care research, the focus must not focus on the disclosure of risks to an extent that other requirements of respect for persons are ignored.


A critique of clinical equipoise. Therapeutic misconception in the ethics of clinical trials.
A predominant ethical view holds that physician-investigators should conduct research with therapeutic intent, but this perspective is flawed, and clinical equipoise should be abandoned.
False hopes and best data: consent to research and the therapeutic misconception.
Appelbaum et al. suggest ways in which patients can be made to understand the differences between treatment and research, and the disadvantages and advantages of participation in the latter.
  • R. Dresser
  • Psychology, Medicine
    Social Philosophy and Policy
  • 2002
The term “therapeutic misconception” was coined in 1982 by Paul Appelbaum, Loren Roth, and Charles Lidz after participants in several psychiatric studies tended to believe that therapy and research were governed by the same primary goal: to advance the individual patient's best interests.
The Clinician-Investigator: Unavoidable but Manageable Tension
This work addresses the ethical tensions inherent in the role conflict and argues that the tensions are real but manageable, and provides a sound ethical framework within which to manage those tensions.
The therapeutic misconception: informed consent in psychiatric research.
Trust, Emotion, Sex, Politics, and Science: Surveying the Risk‐Assessment Battlefield
  • P. Slovic
  • Education
    Risk analysis : an official publication of the Society for Risk Analysis
  • 1999
It is argued that danger is real, but risk is socially constructed and there is a need for a new approach to risk management that focuses upon introducing more public participation into both risk assessment and risk decision making in order to make the decision process more democratic, improve the relevance and quality of technical analysis, and increase the legitimacy and public acceptance of the resulting decisions.
The therapeutic orientation to clinical trials.
Clinical trials have been understood as continuous with clinical medicine as the physician makes observations, investigates, tests hypotheses, and investigates hypotheses.
"He Knows That Machine is His Mortality": Old and New Social and Cultural Patterns in the Clinical Trial of the AbioCor Artificial Heart
The clinical trial of the AbioCor artificial heart, initiated in July 2001 and still in process, has taken place within a matrix of social and cultural patterns that are both "old" and new." The old
Challenges of Teaching Surgery: Ethical Framework
Disclosure of the role of trainees and their contribution to care enhances trust in well structured training programs to ensure skill development and patient safety.
Ethical issues relating to the use of antimicrobial therapy in older adults.
  • E. Marcus, A. Clarfield, A. Moses
  • Medicine
    Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
  • 2001
The difficult decisions regarding whether one should withhold treatment can be based on consideration of the ethical principles of autonomy, beneficence, nonmaleficence, and justice and the need to avoid the emergence of antimicrobial resistance.