Current literature suggests that therapeutic misconception
– a belief by participants in a clinical trial that they are in fact
simply being given clinical care – is common, especially among
illiterate populations in developing countries. Therapeutic
misconception reflects problems in informed consent, as
people agree to participate in clinical trials without being
aware that the trial procedures and test products may not in
fact benefit them.
In this study of Malawian adults who had participated in
research projects of various kinds during the preceding
years, we found that the majority participated in research for
the sake of obtaining better quality treatment made available
through the clinical trials as ancillary care. Their consent to
participate was not due to a belief that the actual procedures
of the trial would directly benefit their health. Respondents
indicated that, government hospitals being crowded and
commonly lacking drugs, they agreed to take part in research
projects in the hope of obtaining access to ancillary care
provided by clinical trials.
We conclude that in this environment, possibly owing to
inadequacy of routine health services, people make rational
decisions to participate in research. We question whether
the term ‘therapeutic misconception’ accurately describes
participants’ motivation under conditions of limited
resources. We also discuss the relevance of these findings
for understanding undue inducement in clinical trials.