tag:blogger.com,1999:blog-1732132352927731247.post5407350591514434550..comments2024-03-16T00:27:31.848-07:00Comments on Hooked: Ethics, Medicine, and Pharma: Equipoise: No Help for Ethical DeliberationHoward Brodyhttp://www.blogger.com/profile/00599587504924835039noreply@blogger.comBlogger5125tag:blogger.com,1999:blog-1732132352927731247.post-32613923637314372302011-02-07T02:18:45.304-08:002011-02-07T02:18:45.304-08:00This site was great, It may be possible to make a ...This site was great, It may be possible to make a recommendation for an individual in favor of one of two unproven interventions based on the individual’s unique symptoms, side effects, values, preferences, etc.snore stophttp://www.thesnoringstop.com/noreply@blogger.comtag:blogger.com,1999:blog-1732132352927731247.post-10890315240880098792011-02-04T10:44:33.184-08:002011-02-04T10:44:33.184-08:00Hello, Howard.
I inferred from the essay by Mille...Hello, Howard.<br /><br />I inferred from the essay by Miller and Joffe that the authors themselves drew conclusions about the conduct of clinical research using the term equipoise--as in "equipoise-driven consequences," without adequately defining the term.<br /><br />Whose responsibility is it to define the concept of equipoise, if not academicians and NIH bioethicists? <br /><br />Alex John London (Two Dogmas of Research Ethics and the Integrative Approach to Human-Subjects Research) proposes an integrative model for clinical research that “respects the fundamental moral equality of all community members...." More here:<br /><br />http://tinyurl.com/4w4cwb9Nancy Wilsonhttps://www.blogger.com/profile/00094553230235804728noreply@blogger.comtag:blogger.com,1999:blog-1732132352927731247.post-15446961362459868132011-02-04T08:17:48.501-08:002011-02-04T08:17:48.501-08:00Nancy Wilson may have inferred from my terse comme...Nancy Wilson may have inferred from my terse comments that it was the authors of the paper I am reviewing here, Miller and Joffe, who failed to provide an operational definition of 'equipoise.' I intended rather to convey that Miller and Joffe make the claim in their paper that it is the advocates of the equipoise criterion who have failed to offer any workable, practical definition of when equipoise holds and when it doesn't. That failure is one of the reasons to reject equipoise as a workable ethical principle in research. I also agree that Christine Grady's comment is an insightful one, and makes clear the important ethical diference between the respective roles of treating physician and trial investigator.Howard Brodyhttps://www.blogger.com/profile/00599587504924835039noreply@blogger.comtag:blogger.com,1999:blog-1732132352927731247.post-77276629161630435442011-02-04T03:19:45.859-08:002011-02-04T03:19:45.859-08:00. It may be possible to make a recommendation for .... It may be possible to make a recommendation for an individual in favor of one of two unproven interventions based on the individual’s unique symptoms, side effects, values, preferences, etc.anti snorehttp://www.antisnores.com/noreply@blogger.comtag:blogger.com,1999:blog-1732132352927731247.post-26834969264428296732011-02-03T23:58:15.787-08:002011-02-03T23:58:15.787-08:00The authors’ failure to provide an operational def...The authors’ failure to provide an operational definition for equipoise weakens their argument, in my opinion. The more pressing problem here is the lack of evidence-based literature on the concept of equipoise.<br /><br />I like Christine Grady's take on equipoise in Principles and Practice of Clinical Research (2002) on page 23:<br /><br />“It is important to recognize that there is a distinction but not necessarily a contradiction between a state of equipoise, necessary for the conduct of an RCT, and offering a treatment recommendation for an individual patient. Not knowing which of two or more interventions is superior in terms of long-range outcomes for a group of patients does not preclude judgments about what is best for a particular patient at a particular time. It may be possible to make a recommendation for an individual in favor of one of two unproven interventions based on the individual’s unique symptoms, side effects, values, preferences, etc. The greatest tension in this regard may be in the case of a clinician, responsible for the care of patient, who also is the investigator of a study in which the patient is a subject. Being aware of this tension, clearly informing the patient, relying on other members of the team, or in some cases, separating the roles of clinician and investigator may be necessary so that the patient’s needs are not overlooked.”Nancy Wilsonhttps://www.blogger.com/profile/00094553230235804728noreply@blogger.com