PrepTest 147

Incorrect. (Lines 12-13; Line 48) This is a very tempting answer because it highlights a situation where a preference is developed for one treatment over another, but it's ultimately wrong for two reasons. First, it doesn't state that the trial continued after these initial results—it may have ended once the initial results were released, and thus it didn't run afoul of clinical equipoise. Second, in noting that "most" experts came to favor one treatment, the argument suggests that there was consensus on that treatment, and thus continuing the trial may have violated clinical equipoise as well.

Incorrect. (Lines 12-13) If the initial results suggest that the two treatments are equally effective, then there wouldn't be a preference for one over the other, and no ethical question is raised under theoretical equipoise.

Incorrect. (Line 48) Clinical equipoise is based on an "absence of consensus within the expert clinical community," so since this situation has a consensus, this situation would violate both types of equipoise.

Correct. Question Type:
Cannot Be True

Strategy Overview:
Focus on the differences between the two types of equipoise and find an answer that contradicts theoretical but not clinical

Answer Anticipation/Relevant Lines:
First, let's talk about why we're calling this a Cannot Be True question. The correct answer will violate ("jeopardize") theoretical equipoise. In other words, it'll run counter to that ethical standard—or contradict it. Contradictions are the world of Cannot Be True questions. It also can't violate clinical equipoise, but it doesn't have to be something that must align with that theory ("more likely to jeopardize"), so we just need something that doesn't contradict clinical equipoise. That's still in the Cannot Be True world.

So what are the differences? Theoretical equipoise says that physicians participating in clinical trials "should have no opinion as to which treatment" is better (Lines 12-13). Clinical equipoise, on the other hand, can work when individual researchers "have a decided treatment preference" (Line 51) but there's an "absence of consensus" (Line 48) in the medical community.

So the key difference is individual preference for one treatment over the other. Having such a preference and participating in a trial is unethical under theoretical equipoise, but it's ethical under clinical equipoise as long as that preference isn't the consensus opinion. Let's find an answer where there's a preference for one treatment over another.

Answer Explanation:
(Lines 12-13; Line 48) In this situation, there are some experts who believe one treatment is better than the other. According to theoretical equipoise, they can't ethically participate in the study anymore since they have an opinion as to which treatment is superior. Under clinical equipoise, however, the lack of consensus and its recognition by those who do have a preference means that ethical participation is still possible. Since this answer presents a problem under theoretical equipoise but not under clinical equipoise, it's the correct answer.

Key Takeaway:
Comparative language in the question stem probably means you should be thinking about comparisons when anticipating an answer. Here, the question was about what would "more likely" create problems under one theory than another. We compared those two theories, and it let us home in on what the answer choice should discuss.

Incorrect. (Line 48) In this situation, the consensus view among participants is that neither treatment is better than the other being tested, and so it poses no ethical problems under theoretical equipoise because there's not a belief that one treatment is better than the other.