Reading Comprehension

PT147 · S3 · P3 · Q21 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.

21.

The author's argument in the third and fourth paragraphs would be most weakened if which one of the following were true?

Correct
In most comparative clinical trials,
Why this is right
This answer primarily goes against the claim towards the beginning of the 3rd paragraph that "equipoise would impose rigorous ethical standards without unreasonably constricting them". This answer choice makes it sound like clinical equipoise (just like theoretical) would still make it an ethical problem for physicians to take part in most comparative drug trials. Clinical equipoise allows physicians to participate when the medical community at large is still undecided which of two treatments is better. But if, as this answer says, most comparative trials are pitting one drug (considered best by a consensus of medical experts) vs. another drug, then participating physicians would not be in a state of clinical equipoise. If there's a consensus in the medical community, then clinical equipoise is impossible. It requires (as the end of the 3rd paragraph says) that medical experts are divided as to which treatment is better. So this answer choice weakens by showing that clinical equipoise would also not be possible for most comparative trials; thus, it's not clear that it's any better than theoretical equipoise.
Skill tested: Weaken · how this choice captures the passage's function is the move to repeat next time.
47% picked this
Physicians participating in comparative clinical
Do vs. Should
Whether physicians rarely or frequently do ask to leave trials is kind of beside the point. If we use a standard of theoretical equipoise, then physicians often should be asking to leave a trial because they've started to form a judgment on which treatment is superior. This answer is also suspicious since it's borrowing language from the 2nd paragraph, which was where we talked about why theoretical equipoise was problematic.
6% picked this
The number of comparative clinical
Unclear Impact
In a sense, we might say this strengthens the author's case for using clinical equipoise, since it's an easier ethical standard to meet than theoretical equipoise is. If we're conducting more and more comparative trials, then we're going to need an ethical standard that is more frequently attainable.
7% picked this
Medical ethicists are more inclined
No Impact
Given that theoretical equipoise is the tougher ethical standard (but hard to pull off in practice), it's unsurprising to hear that ethicists like it more than researchers. Ethicists are more likely to think about what would be great in an ideal world, whereas the author is trying to sell clinical equipoise based on the realities of what takes place in the real world. The author surely realizes that his idea will probably be embraced more by practicing physicians than by ethicists, so this answer isn't really hurting his feelings too much.
6% picked this
In clinical trials comparing two
Not as Good as (A)
This answer choice makes it sound like one of the ways in which theoretical equipoise could be destroyed (no preference at first, but early data leads to a strong preference) is a rare occurrence. In other words, this answer makes it seem like one of the potential problems associated with theoretical equipoise is pretty rare. However, this answer is saying it's rare that the researchers develop a strong preference on the basis of early data. There's still plenty of room for them to develop some preference on the basis of early data. And there's plenty of room for them to develop a moderate / strong preference based on data obtained in the middle of the study. So even once you accept that the specific dealbreaker for theoretical equipoise described in this answer is rare, you still have many possible cases in which theoretical equipoise could be a frequent dealbreaker.
34% picked this

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