Suppose two medical treatments are being compared in a clinical trial for their effectiveness in treating a condition...

Victoria on June 12, 2019

Hi @Shiyi-Zhang,

Let's start by going through the passage.

The first paragraph outlines the issues to be discussed in the article. Medical practitioners are ethically required to prescribe the best available treatments to their patients. Normally, this is not a problem; however, issues arise when medical practitioners are conducting comparative studies of medical treatments. This is because comparative studies of medical treatments require that at least one group of patients does not receive at least one of the possible treatments which means that the practitioners are, in some cases, neglecting their ethical responsibility to prescribe the best available treatment for the sake of comparative research.

The first paragraph concludes by introducing the concept of "equipoise." Most medical practitioners and ethicists agree that, when testing a new treatment, the researchers should have no opinion as to which treatment is medically superior. In other words, most medical practitioners and ethicists agree that the researchers should conduct their study in a state of "equipoise."

The second paragraph discusses the idea of theoretical equipoise, or the usual employment of the concept. The author argues that this state of theoretical equipoise can exist only when the evidence supporting two treatments of study is perceived by the researchers to be exactly balanced. This rarely occurs in practice as the researchers commonly prefer one treatment over another, often based on intuition or interpretation of evidence. Even in the rare cases where the evidence is perfectly balanced, the researcher would likely develop a preference as the study progressed. The author argues that this standard of theoretical equipoise limits the potential of clinical trials.

The third paragraph introduces the author's concept of a new standard of "clinical equipoise." The author claims that this would "impose rigorous ethical standards on comparative clinical trials without unreasonably constricting them." The author supports this new standard by reminding the reader that one of the purposes of comparative clinical trials is to resolve conflict over which treatment is superior; conflict which is common within the medical community.

In the final paragraph, the author argues that the fact that conflict exists within the medical community is what makes clinical equipoise possible. The researchers must simply recognize their own preferences and the way that they fit into the broader medical community's perceptions while conducting the study.

The question stem asks us to identify the scenario wherein the clinical comparison of two hypothetical medical treatments would be more likely to jeopardize theoretical as opposed to clinical equipoise.

Answer A is incorrect because it addresses the preferences of physicians who specialize in treating the condition as opposed to the clinical researchers themselves. Theoretical equipoise exists when clinical researchers judge the evidence to be balanced. As the practicing physicians have no impact on the comparative study, it does not matter what they believe. In assessing equipoise, we are focused on the preferences of the clinical researchers as they are the ones whose inherent preferences impact the study and its conclusions.

Notice in the correct answer (D), it clearly states "participating physicians," i.e. the clinical researchers. This scenario jeopardizes theoretical equipoise as the researchers become convinced that one treatment is superior to the other partway through the study. It does not jeopardize clinical equipoise as it facilitates conflict but the researchers also recognize their own preferences and how they fit into those of the medical community.

Hope this is helpful! Please let us know if you have any further questions.