LETTER TO THE EDITOR: ‘Unrealistic Optimism’ or Losing Sight of the Forest for the Trees?

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The article: “Unrealistic Optimism Poses Ethical Challenges, May Affect Informed Consent Process” (The ASCO Post, September 1, 2011, page 35) seems to be delving into a subject with an intent that is unclear.

I agree fully with Dr. Jimmie Holland that discrimination between “optimism” and “unrealistic optimism” is not only unhealthy, but also purports to illustrate that these researchers, from their “superior stance,” are attempting to judge the “hope” and “optimism” qualities of our patients.

As a hematologist-oncologist, hope is crucial, and I believe it is of significant benefit to the overall well-being and health of my patients. Good dialog, ongoing discussions, and a connection to one’s oncologist allow a patient’s expectations, and hope and optimism, to change and adjust with time and circumstances. The participants in trials always hope for some benefit, whether to the larger base of knowledge and patients in general, or also for themselves if possible. This is human nature, which is remarkably resilient and courageous. It appears these researchers from their “ethics platform” are confusing this subject and have lost sight of the forest for the trees, so to speak.

The real focus in hematology-oncology ought to be directed more accurately toward addressing the travesty in our country of having patients who are uninsured, let alone the staggeringly high cost of chemotherapy treatments. Now, that would be practicing “ethics” at a very high level. ■

—Stephen G. Chandler, MD
Portland, Oregon





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