вЂњOptimistic biases are part of human psychology.вЂќД«ut placed in the context of early-phase clinical cancer trials, unrealistic optimism results in a perfect ethical storm. вЂњNo one is immune to this kind of bias,вЂќ Dr. But unrealistic optimism can be present in anyone, regardless of whether they have a generally optimistic outlook. Social psychologists point to smokers who underestimate their chances of getting cancer or gamblers who believe they will beat the odds as classic examples of unrealistic optimism. вЂњIf you have more than 50 percent of patients saying their chances are better than average of avoiding some harm or obtaining some benefit, they are being unrealistically optimistic because you canвЂ™t say that most people are above average.вЂќ Sulmasy, senior author and a professor of medicine and ethics at the University of Chicago.

вЂњItвЂ™s the Lake Wobegon effect, вЂќ said Dr. In essence, they believed they would fare better than the average patient enrolled in the same trial. A majority of patients assumed that the experimental drugs would control their cancer and that they would experience benefits but not complications. But despite clearly understanding the purpose, and limits, of early-phase trials, the patients were also blinded by what researchers called an вЂњunrealistic optimism,вЂќ or an optimistic bias, when it came to applying that knowledge to their own particular situations.

A solid majority understood that the trialsвЂ™ purpose was to advance research, not to treat them. The ethicists surveyed 70 patients enrolled in several early-phase cancer trials and asked them about their expectations and understanding of their respective trials. It turns out that when it comes to being hopeful, not all optimism is created equal. Now one group of ethicists has just published a study challenging that assumption. This time she would participate in one of the earliest studies of a brand-new drug, a Phase I clinical trial, and would have to undergo major surgery before taking the experimental drug. Nonetheless, when her cancer began growing again, she eagerly applied for a third study. She had endured countless hospitalizations, serious bloating, a punctured lung, overwhelming fatigue and two nearly intractable infections. Her tumor had responded slightly during one of those studies, but slowing the pace of its growth had come at a significant price. By the time I met her, she was already the veteran of two clinical trials at the center. Known for her cheery disposition В— she reminded the doctors and nurses of a brunette Cathy Rigby В— she had melanoma that had spread through her body despite efforts to halt its growth. One of the patients was a woman in her late 30s, a mother of three. Every week, patients with rare diseases and cancers that had not responded to standard therapy arrived from all over the country, eager to try something new, even if the efficacy of the treatments had not yet been proven. As a medical student and later during my residency, I trained for some time in a medical center known for its research and clinical trials.

Unrealistic optimism bias