I recently saw a patient who was interested in participating in a blood pressure clinical trial. Her main apprehension was that her daughter did not want her to be experimented on.

I proceeded to explain to her the typical sequence of events that would have occurred if she consulted me for her blood pressure problem in my medical office:

1. I check my watch before entering the exam room.

2. I calculate 8 minutes to solve the problem; since I am already an hour behind schedule and have 20 unanswered phone calls waiting for me.

3. I check the blood pressure that the nurse took, then listen to her heart and lungs.

4. I run to the drug sample cabinet, select a sample antihypertensive medication, and return to the exam room.

5. I tell her to try the medication, call if she has any problems, and schedule a return visit in one month.

I then explained the sequence of events that would occur in the clinical trial she was interested in :

1. She first reads an informed consent that explains the entire clinical trial, including any risks or potential side effects.

2. After reading the consent, I sit down with her to make sure she understands everything and to answer any questions.

3. She then undergoes a complete medical history, complete physical exam, electrocardiogram, and blood work.

4. After the results of her studies come back, I review them with her and check all the results against the inclusion and exclusion criteria for the clinical trial to make sure it is safe for her to participate.

5. If everything checks out, she is given the clinical trial medication and a follow-up visit is scheduled for one week.

6. She is told to call with any concerns or problems in the interim.

The decision making process in the first scenario takes about 5 minutes. In the second scenario, the patient is evaluated by me and the nursing staff for approximately 2 hours before the decision to administer the blood pressure medication is made.

I left my medical practice years ago to do full-time research so that I could stop experimenting with patients and spend the proper amount of time with them, like I did before managed care changed medicine.

Nicholas Messina M.D.

Dr. Messina became a Board Certified Family Practitioner in 1985. He was in solo practice until 1994.He then helped form a group Family Practice in which he served as Vice President.

He left group practice in 1997 and became the Medical Director of a Wellness Center. He was responsible for coordinating the efforts of nutritionists, acupuncturists, massage therapists, exercise physiologists, and Chinese medicine practitioners into integrated medical care plans that were individualized to the patient.

He became the Medical Director of an independent clinical research facility in 2000. He has been the Principal Investigator in over 50 clinical trials involving osteoarthritis, diabetes, hypertension, hypercholesterolemia, chronic pain, depression, anxiety, dry eye, migraine, and diabetes prevention.

He has served as consultant to a nutritional company, and has formulated nutritional supplements.

By way of his website,his vision is to provide a road map for healthy living in today's hectic world.

As the site grows, information on diet, exercise, nutritional supplements, and stress reduction will be provided. Common illnesses will be explained, as well as their treatments.

He will continue to formulate and make available healthy, reliable, nutritional supplements.

Through the miracle of technology, he hopes to spend the same quality time with the many as he now does with the few.

He intends to accomplish this through the addition of free content on medical illnesses, a free newsletter, and eventually the addition of e-books and e-courses on specific topics.