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This passage deals with the ethical requirements of medical practitioners to provide the best
medical treatment, and the special issues that arise in comparative treatment studies, which involve
withholding at least some of the treatments studied from at least some participants. When there
is a traditionally accepted treatment available, traditionally doctors and ethicists have agreed that
participating physicians should have absolutely no opinion as to what treatment is superior. This
ambivalent state of mind is referred to as “equipoise.”
This next paragraph begins with a central point of the entire passage: “theoretical equipoise,” which
is how the author refers to the traditional definition of equipoise, “may be too strict.” Such a state
implicitly requires a perfect balance of evidence for each treatment—a standard which, the author
notes, is nearly unattainable. Researchers often have preferences based on intuition, interpretation,
and a balancing of the evidence available. Even if attaining a state of theoretical equipoise were a
possibility, the author points out, such a balance would be tenuous, easily tipped by evidence on
either side of the issue. As such, the impractical standard of expected equipoise would be difficult to
achieve and even harder to maintain.
Following up on the discussion of potential issues with the standard of theoretical equipoise, the
author now turns to the suggestion that a different standard be adopted. “Clinical equipoise,” says the
author, would impose standards that are rigorous but not overly restrictive. After all, says the author,
one reason for comparative trials is to resolve conflicts in expert opinion and in the interpretation of
In the closing paragraph, the author continues to make the point that clinical equipoise is possible
because of the conflict in opinion that is an inherent part of comparative studies. A decided
preference on the part of a researcher, asserts the author, should not bar participation, as long as
the researcher recognizes that the other treatment is preferred by “a sizable constituency within the
medical profession as a whole.”
This passage presents the Viewpoint of the author, as well as the traditional perspective of “most
physicians and ethicists.”
The Structure of the passage is as follows:
- Paragraph 1: Introduce the special issues that arise in the case of comparative clinical trials;
define “equipoise” as the desired state of mind for physicians conducting such
studies, who should have no opinion as to which of the studied treatments
would be preferable.
Paragraph 2: Note that the traditional notion of theoretical equipoise may be too restrictive,
in that it requires the avoidance of any preference on either side, making such
a state of mind hard to achieve and even harder to maintain.
Paragraph 3: Suggest the new, less restrictive notion of “clinical equipoise,” which would
set a rigorous standard without unreasonable constraints. Note that one reason
for such trials is to resolve conflict in the medical community.
Paragraph 4: Point out that a lack of consensus in the medical community makes clinical
equipoise possible; a physician conducting a comparative trial may have
strong preference for one treatment, which should not be an issue so long as
the physician notes that the alternative treatment is preferred by a sizeable
constituency among medical experts.
The author’s central Argument is that theoretical equipoise is such a strict standard that it might
be unachievable, which is why it should be replaced by a less restrictive , more realistic standard of
The Main Point of the passage is to argue for the standard of clinical equipoise to replace the
traditional notion of theoretical equipoise as the standard for comparative clinical trials.