A question that has developed in the implementation of clinical trials into the hospital setting is due to the standard of care versus investigational agent nature of many studies. As a result, it means that one arm of the study is inferior to the other, although of course it is not known which one. The matter is supposed to be addressed by an Institutional Review Board. Patients also undergo informed consent to be aware of this, and other, aspects of the study. However, does it still present an ethical issue, despite these safeguards? My interest lies in not only the ethical question, but the difficulty this aspect may present in establishing a clinical research program in a hospital. 

I attended the BOG review course in San Diego last month, & Dr. Nowicki stated a scenerio that was a real eye opener.  He stated something along the lines of:  If you knew as an healthcare executive that you would be going out of business say a year from now, would you let your leaders in the organization know?  The answer he stated was, No, because your obligation is to your patients, not your employees.  If you let your leaders know, you'd probably lose your good leaders because they'd find placement elsewhere & you'd be stuck with the ones that are not so good because they wouldn't be able to find a job elswhere.  I just was blown away by this thought, but he's go a point.