Reading Comprehension

PT147 · S3 · P3 · Q16 Theoretical vs. Clinical Equipoise

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The following passage is based on an article published in 1987.

Topic

Clinical vs. Theoretical Equipoise

Framework

Old vs. New / Problem vs. Solution

Main Point

OLD/PROBLEM -- theoretical equipoise, which holds that physicians can't take place in a drug trial comparing two different treatments unless they are equally confident in both options.

NEW/SOLUTION -- clinical equipoise is a more attainable, but still sufficiently robust, standard that means as long as there's good-faith dissension within the medical community (i.e. the medical community is still agnostic about which is the better treatment), then physicians have no ethical qualms participating in the comparative drug trail.

Summary

P1 - Background of Old

Author explains physicians' ethical standard (prescribe best treatment) and application of that standard to the thorny issue of comparative drug trials. Introduces the concept of theoretical equipoise.

P2 - The Old way is a Problem

The author explains the ways in which theoretical equipoise sets too high a bar, one that would make it too hard to start a drug trial or to complete one, once early evidence starts trickling in.

P3 - The New Solution

The author outlines what clinical equipoise would be, a standard that would mean an individual physician can have a preferred treatment in a comparative drug trial as long as the broader medical community has not yet registered a consensus on a preferred treatment.

P4 - Implications of New/Solution

The author takes a victory lap explaining how clinical equipoise hits that Goldilocks spot of just ethical enough, just practical enough.

16.

According to the passage, which one of the following is true?

  1. Comparative clinical trials that meet

    Too Strong: generally / no

    This is saying that more than 50% of trials that meet the standard of theoretical equipoise have zero ethical problems. That sounds somewhat reasonable, since theoretical equipoise is a tough standard to meet, but we can't find any support text that allows us to make this strong generalization. Equipoise only deals with the issue of whether participating physicians have an opinion about which treatment is superior. There are lots of other ways that a trial could be unethical (maybe someone has a conflict of interest because they would stand to gain money from a certain outcome / maybe the trial is being conducted on unconscious patients without their consent).

    5% picked this

  2. Clinical researchers are often forced

    Ideal vs. Actual

    This answer is similar to what's being said in the 2nd paragraph, but there the author is saying, "If, in practice, we actually held ourselves to the standards of theoretical equipoise, then we would often be forced to suspend comparative trials because the initial data favored one treatment over another". But the author is saying this "ideal is hardly attainable in practice". Clinical researchers are not actually playing by the rules of theoretical equipoise, so they're not actually forcing themselves to prematurely shut down a trial once early accretions of evidence tip the scales in favor of one treatment over the other. The final sentence of the 2nd paragraph is where we're hearing about prematurely shutting down a trial prior to completion, but that sentence is in a conditional tense, not an actual past/present tense: If the standard of theoretical is adhered to, few trials could proceed to completion. But the author's point is that the standard of theoretical isn't adhered to because it's unrealistically stringent, and that's why she's developing this more pragmatic standard of clinical equipoise.

    14% picked this

  3. Correct

    A clinical trial comparing treatments

    Why this is right

    This has the "come hither" tractor beam of lovably soft language. It has the form: "Something is not X merely because of Y" That's a very weak claim that means, "It's possible for something to be Y, but not X". Does our author think that it's possible that one of the participating physicians has come to favor one of the treatments, but the clinical trial is still "ethical"? Sure! That's her whole reason for writing this passage and developing the standard of clinical equipoise. Within clinical equipoise, a physician is allowed to favor one of the treatments as long as there is still a lack of consensus in the expert clinical community. And clinical equipoise "would impose rigorous ethical standards".

    Skill tested: Locate Detail · how this choice captures the passage's function is the move to repeat next time.

    69% picked this

  4. A comparative clinical trial that

    Opposite, if anything

    The whole point of this passage is that theoretical equipoise is too stringent. It's too high of a bar to clear. If we followed that standard, we'd almost never be able to start or finish clinical trials. So, instead, we should use a different standard: clinical equipoise. It's a much lower bar to clear. The participants don't need to have "no opinion / no preference". They are allowed to have an opinion, as long as the expert community still hasn't come to a consensus. This answer is saying that clearing the much lower hurdle of clinical equipoise would also mean that you've cleared the much taller hurdle of theoretical equipoise.

    6% picked this

  5. Medical researchers generally try to

    Too Strong: generally

    This is saying that "more than 50% of medical researchers are conducting clinical trials in accordance with" the standard of clinical equipoise that this author just invented in this passage. She is suggesting that a different notion of equipoise be developed, one that she chooses to label clinical equipoise. It seems fishy to say that most medical researchers are trying to conduct clinical trials in accord with this new concept the author just invented. There isn't any generalization in the passage about what most medical researchers are doing.

    6% picked this

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