Reading Comprehension

PT147 · S3 · P3 · Q17 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.

17.

Suppose two medical treatments are being compared in a clinical trial for their effectiveness in treating a condition. Based on the passage, which one of the following scenarios would be significantly more likely to jeopardize theoretical equipoise than clinical equipoise?

  1. The initial results of the

    Inconsistent with Both

    Theoretical E thinks the trial should shut down once the doctors become partial. This one didn't, it seems. The results were published halfway through, but it sounds like they kept going at it. Clinical E would be tolerant of doctors having an opinion, if the the field of professionals is collectively undecided. But here, it's drifting towards the idea that the collective (most physicians) is reaching a consensus.

    29% picked this

  2. Preliminary results in the trial

    Consistent with Both

    Since no doctors are being tipped towards one of the drugs, there is no threat of violating Theoretical or Clinical equipoise.

    5% picked this

  3. Several of the physicians participating

    Inconsistent with Both

    This is just like (A). Theoretical would be mad that any clinical trial is going on, given that doctors are partial. And Clinical would be mad that there's a consensus in the field, since Clinical only tolerates doctors' having preferences for a drug if the medical field is overall undecided on that drug.

    17% picked this

  4. Correct

    Initial results from the trial

    Why this is right

    What separates this from (A) and (C) is that in this example, there is a lack of consensus in the field. The first sentence of the last paragraph says that "the very absence of consensus is what makes clinical equipoise possible". This answer is written obnoxiously, no doubt -- "this does not affect their recognition of X" = "they still know/recognize that X is true" So this is establishing that in the minds of these partial doctors, there is still not a consensus in the field.

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

    42% picked this

  5. There is consensus among physicians

    Consistent with Both

    Since the doctors think that both treatments are equally effective, there is no danger for Theoretical or Clinical equipoise to be violated. Once the doctors have a preference, meaning once they think that one drug performs better than the other, than Theoretical says, you can't be a part of the study. Clinical says, you can be a part of the study if there's no consensus in the field. But in this example, like (B), the doctors weren't being tipped towards one drug over the other.

    7% picked this

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