Theoretical vs. Clinical Equipoise

Answer choices

1. A

   Too Strong: most1% picked this

   Most clinical trials that are conducted meet the appropriate

   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%
2. B

   Unsupported Comparison12% picked this

   Clinical trials would be conducted more often if there were a more reasonable ethical

   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.

   12%
3. C

   Correct70% picked this

   Theoretical equipoise imposes an ethical standard on clinical trials that is rarely

   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.

   70%
4. D

   Out of Scope: belief of adequacy5% picked this

   Most physicians and ethicists believe that the currently accepted ethical requirements for comparative clinical

   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%
5. E

   Too Strong: most12% picked this

   Most comparative clinical trials are undertaken to help resolve a conflict of opinion in the expert clinical community

   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%