The article by Novack et al (p 897) reports a change in physicians' attitudes toward this question. Physicians are aware of several important social changes in our culture that have contributed to this change. Many could be mentioned, including the dramatic change in the malpractice situation that encourages physicians to minimize liability by transferring knowledge to the patient; the laws mandating freedom of information, which have brought the confidentiality of the physician-patient relationship to the public; the effects of federal legislation affecting payment of physicians' fees through insurance carriers; the Professional Standards Review Organization; and other types of professional review activities, including the Food and Drug Administration review of informed consent documents.
However, in addition to these social changes, there is an important positive aspect in sharing prognostic information with the patient—the growing importance of clinical research in health care. Clinical science and therapeutic research during the last 30 years