Tomorrow’s patients: preferences and interests are not synonymous

In their otherwise excellent article Lynch and Largent conflate “preferences”—informed by hope—with “interests”—which should be determined by evidence demonstrating that drugs can improve patients’ lives or allow them to live longer.1 Unsurprisingly, some people who have serious diseases with limited treatment options seek expedited access to drugs that they hope might bring them benefit, particularly when such hopes are cultivated by a potent nexus of hype involving industry, charities, politicians, and the press.In fact, the interests of future patients are almost entirely consistent with the interests of present patients. As the authors indicate, it is in the interest of both current and future patients that research demonstrates that a drug yields benefits for patients.Instead, as the authors relate, the bar has been lowered from achievement of outcomes that matter for patients, such as extending or improving life, to fulfilling speculative surrogate endpoints with no demonstration of patient benefit. Faced with…
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