Self-study
The following passage is based on an article published in 1987.
P1
███████ █████████████ ███ █████████ ████████ ██ █████████ ███ ████ █████████ ███████████ ██ ████████ █████████████████ █████████████ ████ ██████████ ██ ██████████████ ███ ████ ██████████ ███ ████████ ███████████ ██ ███████████ ███████ ██ ███████ ███████████ ███████ ██████ ██████ ███████████ ████████ ██████ ███████ ███████████ ███ ██ ████ ██ ███ ██████████ ████ ██ █████ ███ █████ ██ █████████ ███
Intro topic ·
Problems arise in comparative clinical studies of medical treatments
These trials involve withholding one or more treatments from at least one group of patients. This creates ethical issues.
Traditional standard ·
Equipoise (no opinion)
The traditional view is that doctors participating in comparative clinical trials shouldn't have an opinion about which treatment is more effective
P2
██████████████ ███ ██████████ ██ █████████ ████ ██ █████████ ████████████████ █ ████ ████ ████████████ ████████████████ ██ ███ ███████ ███████████ █████████ ██████ ████ ████ ███ ███████ ████████ ███ ████ ██ ███ █████████ ████████ ██ ██████ ██ ████ ████████ ██████████ ██ ██ ███████ █████████████ █████ ██████ ██████████ ██ █████████ ████████ ███████████ ████████ ████ ████ ██████████ ███ ███ ██ ███ ██████████ █████ ███████ ██ █████████ ██████████ ████████ ██ ███ █████ ██ █████ ██████████████ ███ █████████ ██ ███████ ███████ ██ █████████ ████ ██ ███████████ ██████ ███ ████████ ██ ██ ████████ ██ ███ █████ ██ █ ███████████ ████████ ██████ ████ █ ███████ █████ ██ █████████ ████████ ██████ ██ ██ ████████ ██ █████ ██████████ ██ ████████ ██ ███ █████ ███████████ █████████████ ██ ███ ████████ ██ ███████████ █████████ ██ ███████ ███ ███ ███████████ ████████ ██████ █████ ████████ ███ ████ █████ █████ ███████ ██ ███████████
Author's perspective ·
Theoretical equipoise is too strict, because researchers will usually have an opinion
Even if at the start a doctor thinks both treatments are equal, as the study continues, it's likely that doctors will develop an opinion about which is better.
P3
█████ ████████████ ██████████ ████ ███████████ █████████ ███████ ████ █ █████████ ██████ ██ █████████ ██████ ██ ██████████ ███ ████ █ ████ █████ █████████ ███████████ ████████ █████████ █████ ██████ ████████ ███████ █████████ ██ ███████████ ████████ ██████ ███████ ████████████ ████████████ █████ ███ ██████ ███ ██████████ ███████████ ████████ ██████ ██ ██ ███████ █ ███████ ██ ████████ ████████ ██ ███ ██████ ████████
Author's proposal ·
Clinical equipoise
Many trials are done to resolve a conflict in the expert community about what treatment is best for a given illness. Experts can be honestly divided about which is better.
P4
███ ████ ███████ ██ █████████ ██████ ███ ██████ ████████ █████████ ██ ████ █████ ████████ █████████ █████████ ███ ██ ████ ██ █ ███████████ ████████ ███████ ███████████ ███ ████ █ ███████ █████████ ██████████ █████ ██ █████ ███████████ ██ ███ █████████ ███ ████ ██ ██ ███████ ███ ██ █████████████ ██ ███ ██████ ███ ████████ ███████████ ████ ██████ ████ █████████ ████ █████ ████████████ █████████ ██ █████████ ██ █ ███████ ████████████ ██████ ███ ███████ ██████████ ██ █ ██████
Elaborate on clinical equipoise ·
As long as there's no expert consensus, the trial is OK
If there's no consensus among experts about which treatment is better, it's OK to do the trial. And it's OK for researchers to have an opinion about which is better.
Passage Style
Critique or debate
Problem-analysis
20.
According to the passage, which ███ ██ ███ █████████ ██ █████
a
Most clinical trials ████ ███ █████████ ████ ███ ███████████ ███████ ██████████
The author views “clinical equipoise” as the “appropriate” ethical standard. But the author never states that “most” trials meet clinical equipoise. Although she thinks clinical trials are more likely to meet clinical equipoise rather than theoretical equipoise, we don’t know that over half of trials met clinical equipoise.
b
Clinical trials would ██ █████████ ████ █████ ██ █████ ████ █ ████ ██████████ ███████ ████████ ██ ██████
Not stated. Although the author indicates that few comparative trials “could” comment and “even fewer could proceed to completion” if we had to stick to theoretical equipoise, we don’t actually know whether people try to stick to theoretical equipoise. So it’s possible that researchers don’t actually try to stick to it. In that case, clinical trials wouldn’t necessarily be conducted more often if we got rid of theoretical equipoise, because nobody might be sticking to theoretical equipoise in the first place.
c
Theoretical equipoise imposes ██ ███████ ████████ ██ ████████ ██████ ████ ██ ██████ ██ ████ ████
d
Most physicians and █████████ ███████ ████ ███ █████████ ████████ ███████ ████████████ ███ ███████████ ████████ ██████ ███ █████████
We don’t know what “most” physicians and ethicists believe about theoretical equipoise. Most of them might also find it too strict, just like the author does.
e
Most comparative clinical ██████ ███ ██████████ ██ ████ ███████ █ ████████ ██ ███████ ██ ███ ██████ ████████ █████████ ██████████ ███ ████ █████████ ██████████
We don’t know that “most” clinical trials are done for this purpose. Although we know that at least some trials are done for this purpose, the passage doesn’t support a claim that over half of trials are done for this purpose.