I thank Dr Carlson and his colleagues for their comments on my editorial, “Let the truth be known.” I was delighted to hear that my thoughts were so evocative.
The objectives of the editorial were 2-fold and should be obvious if the piece is read carefully. First, the fictional vignette was used to demonstrate that guidelines in human research should not be manipulated to the investigator’s convenience. A sterling example is the use of CBCT studies in the retrospective manner that was described in the editorial. The second objective was to challenge the reader to ask whether exposure to CBCT scans of all patients, routine or complex, with new equipment or “older CBCT units with variable settings” is warranted, given the uncertainties of this diagnostic tool as cited in the editorial.
The salient issue, in either the experimental or the treatment arena, is vulnerability. Vulnerability of experimental subjects is protected by several carefully crafted documents, such as the Nuremburg Code, the Declaration of Helsinki, and the Belmont Report, which were necessitated by egregious human subject abuses during the Holocaust and the Tuskegee study. These 3 documents were developed in an effort to instill veracity, autonomy, beneficence, and nonmaleficence as the core of ethical behavior: designed to protect subjects’ vulnerability. The same respect for vulnerability applies to our patients. Both subjects and patients have the right to be spared from even the most remote possibility of harm, and to be made aware of the risks and benefits of anything that is done to them.
I have no intent to pass judgment on any diagnostic or treatment modality. I do challenge Dr Carlson et al and every reader to initiate authentic self-reflection, without prejudice from one’s own commercial or research interests, to determine whether we are protecting our subjects and our patients to the best of our ability in all that we do to them and for them.
In designing research that involves human subjects, it has been said that the most ethical study design is established when the author devises the investigation’s methodology without knowing if he (the author) is the subject or the researcher. That same admonition also applies to the treatment of our patients: it’s called the Golden Rule.