In general naturalistic trials have no individual benefit but do have potential risks, mainly psychic burdens such as worries or stigma tization by (i) the selection of cases, eg, family members in genetic risk studies with regard to information and consent; (ii) the method

of observation and assessment, eg, by interview with intimate questions; (iii) data confidentiality, eg, in epidemiological studies; (iv) “interventions” in marketing trials called “observational or utilization studies.” Major ethical aspects are: method and content of information for consent, data confidentiality; dealing with incidental Inhibitors,research,lifescience,medical findings. Observational trials Up to the 1990s, such studies, mainly postmarketing studies of newly licensed drugs, had a questionable reputation Ruxolitinib because they were often misused as Inhibitors,research,lifescience,medical a marketing instrument: physicians were offered money for observing the effects of a new drug that they were supposed to prescribe

– mainly with meaningless results. However, observational studies without such distorting influence and with a scientifically based methodology18 may yield valuable additional knowledge to the results of controlled clinical trials.19 The aims of such trials could be to gain knowledge about: (i) prescribing behaviors, etc; (ii) undesirable Inhibitors,research,lifescience,medical drug effects of routinely administered drugs under real-world conditions, eg, interactions with other drugs in multimedicated patients with chronic diseases; (iii) the course of the treatment.18 According to the recommendations Inhibitors,research,lifescience,medical of the German Federal Institute for Drugs and Medicinal Products18 the

nonintervention of an observational study is characterized by the separation of the inclusion of patients into the study from the prior decision on the treatment that will follow Inhibitors,research,lifescience,medical usual medical practice. Scientifically sound prospective observational trials should use systematic and standardized observations and a schedule for data analysis laid down prior to the observations. Observational studies are not clinical trials, and the researcher over is not obliged to apply for the vote of an EC. However, he or she is advised to consult an EC, and is obliged to do so if he or she uses procedures beyond the mere routine treatment, eg, a specific questionnaire. Also additional information to the usual information of a patient for his/her consent to treatment should be given, at least regarding the fact that the patient will be included in a study and about the confidentiality of his or her recorded data according to data protection laws. Screening procedures and the problem of incidental findings Screenings almost always result in unexpected incidental findings.