Reading Comprehension

PT147 · S3 · P3 · Q20 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.

20.

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

  1. Most clinical trials that are

    Too Strong: most

    The frequent answer-killer strikes again. Does the author get quantitatively specific? Do we know that more than 50% of trials meet appropriate ethical standards? What are appropriate ethical standards. We know the author is arguing that clinical equipoise would be the appropriate ethical standard, but that one isn't really being used yet. The first sentence of the 3rd paragraph is saying "a different notion of equipoise should be developed". So in the author's mind, maybe no clinical trials are using the appropriate ethical standard yet.

    1% picked this

  2. Clinical trials would be conducted

    Unsupported Comparison

    This one feels very tempting. The author is saying that clinical trials almost never meet the standards of theoretical equipoise, whereas many more would meet the standard of clinical equipoise. However, the author doesn't ever say that we are currently refraining from doing any clinical trials because they don't meet the strict standard of theoretical equipoise. The end of the 2nd paragraph is saying, "If we adhered to theoretical, few trials would start and fewer would finish", but the author isn't saying we actually adhere to theoretical equipoise. She says that theoretical equipoise is the standard of equipoise most typically employed. But equipoise is ultimately a notion of what should / shouldn't be allowed, not what is / isn't going on. In other words, it may be that the same number of clinical trials would happen in the current world as would happen in the clinical equipoise alternate universe. The difference would be that in the theoretical equipoise world, most of those trials would be deemed unethical or the physicians involved would be deemed to have not achieved an equipoise state of mind. And in the alternate universe with clinical equipoise, more of those trials would be seen as having met the standard of equipoise.

    11% picked this

  3. Correct

    Theoretical equipoise imposes an ethical

    Why this is right

    This one is easier to find direct support for than (B). The second sentence of the 2nd paragraph says that theoretical equipoise is "an ideal hardly attainable in practice", which is the same as "rarely if ever met". The last sentence of the second paragraph also works as support, since the author is saying if we adhered to theoretical equipoise, than few clinical trials could commence (which implies that the vast majority of clinical trials fail to achieve the ethical standard of theoretical equipoise).

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

    71% picked this

  4. Most physicians and ethicists believe

    Out of Scope: belief of adequacy

    Does the author get quantitatively specific? Do we know that more than 50% of physicians and ethicists believe the currently accepted requirements are adequate? No, but we are told in the last sentence of the first paragraph that "most physicians and ethicists have agreed that if you're testing a new treatment when a currently accepted one already exists, the participating physicians should have no opinion as to which treatment is clinically superior". We might think, "if most P's and E's think the participating physicians should have no opinion as to which treatment is better, and if the currently accepted ethical requirements are theoretical equipoise, then most P's and E's would be fine with theoretical equipoise." We aren't told, though, that the currently accepted requirements are to have theoretical equipoise. We're told that doctors are ethically required to prescribe the best available treatments. Do we know that most P's and E's find that requirement adequate? Are there other ethical requirements besides "prescribe best treatment" and "have no opinion as to the superior treatment in a clinical trial where an accepted treatment exists"? Possibly. This answer is highly tempting, because it's basically sounding like "most P's and E's believe that what they're currently doing is adequate", but we don't have as strong a line reference for that as we do for the correct answer. Both "currently accepted ethical requirements" (of which we know one or two of an unknown total) and "believe are adequate" are a little too out of scope.

    5% picked this

  5. Most comparative clinical trials are

    Too Strong: most

    The ol' answer-killer "most" returns again. Do we know that more than 50% of comparative clinical trials are undertaken to resolve a conflict about best treatment? No, we can't find anything in the passage that lets us get that quantitatively precise. The third sentence of the 3rd paragraph says "one reason for conducting comparative clinical trials is to resolve a conflict about best available treatment". We don't know if that's the most common reason.

    12% picked this

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