Patient expectations in the clinical investigation of the first use of cortisone in rheumatoid arthritis: Historical vignette

The development of a new treatment modality necessarily means first in human use and brings with it the responsibility to both protect the patient and provide knowledge or benefit that is generalizable to others. Although their motivations and backgrounds vary, researchers and patients both share the excitement of discovery and the consequences of study participation. We report the first use of cortisone in rheumatoid arthritis in 1948, which created great hope when it was developed and applied. The tensions of the study environment created by patient and investigator expectations as well as the effect of the drug led to a complex dynamic, which provided useful lessons for all involved and still affects clinical investigation today.