OVER the past several decades, ethical issues in human experimentation have received increasing attention in the medical literature. Most of this literature presumes a fairly standard conception of modern medical research, ie, the application of a therapeutic intervention to a group of persons with a specific diagnosis. Prototypic examples include comparisons of two drugs, or drug and placebo, for specific diagnostic entities such as cancer. For lack of better terminology, we will refer to these studies collectively as conventional research.
In contrast, the organizational, procedural, and economic aspects of health care provision have themselves become the focus of an enlarging body of research, termed health services research. Until recently, these studies were characterized primarily by either retrospective data collection or concurrent observation without experimental intervention. However, in an attempt to achieve greater scientific rigor, health services research has increasingly included prospective interventions involving human subjects.
The scope of this research