Regarding the article on managed care and clinical trials [M.E. Watanabe, The Scientist, June 24, 1996, page 1]: There is no question that this is a complex problem with roots in the fee-for-service system and the definition of what, for a patient, is treatment and what is research.

If one's life is threatened, the line between treatment and research can become blurred if no proven treatment is available. It may be research for the academic institution, but I believe that most patients in this situation care a lot more for their lives than for furthering research. The question then becomes who pays-the patient and/or his or her insurer or the research funder? Whose interests are paramount here, those of the patient, the third-party payer, or the researcher?

If the patient can pay for the treatment/research, the problem is simplified. If the research funder pays, does this source...

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