Medical practitioners are ethically required to prescribe the best ava

Question

The following passage is based on an article published in 1987.

Medical practitioners are ethically required to
prescribe the best available treatments. In ordinary
patient-physician interactions, this obligation is
unproblematic, but when physicians are clinical researchers
  (5)   in comparative studies of medical treatments,
special issues arise. Comparative clinical trials involve
withholding one or more of the treatments from at
least one group of patients. Traditionally, most
physicians and ethicists have agreed that in testing a
  (10)   new treatment on a patient population for which there
exists a currently accepted treatment, the participating
physicians should have no opinion as to which
treatment is clinically superior—a state of mind
usually termed “equipoise.”

(15)   Unfortunately, the conception of equipoise that is
typically employed—which I will term “theoretical
equipoise”—may be too strict. Theoretical equipoise
exists only when the overall evidence for each of two
treatment regimens is judged by each clinical
  (20)   researcher to be exactly balanced—an ideal hardly
attainable in practice. Clinical researchers commonly
have some preference for one of the treatments being
tested, an intuitive preference perhaps, or one based on
their interpretation and balancing of various sources of
  (25)   evidence. Even if researchers judged the evidence to
be balanced at the start of a comparative clinical trial,
such a balance would be extremely fragile, liable to
be “tipped” by small accretions of evidence as the
study progresses. Consequently, if the standard of
  (30)   theoretical equipoise is adhered to, few comparative
clinical trials could commence and even fewer could
proceed to completion.

These difficulties associated with theoretical
equipoise suggest that a different notion of equipoise
  (35)   should be developed, one that I will label “clinical
equipoise.” Clinical equipoise would impose rigorous
ethical standards on comparative clinical trials without
unreasonably constricting them. One reason for
conducting comparative clinical trials is to resolve a
  (40)   current or imminent conflict in the expert clinical
community over what treatment is to be preferred for
patients with a given illness. It could be that the
standard treatment is A but new evidence suggests
that B will be superior. Medical experts may be
  (45)   divided as to which treatment is better, with each side
recognizing that opposing experts can differ honestly
in their interpretation of the evidence.

The very absence of consensus within the expert
clinical community is what makes clinical equipoise
  (50)   possible. One or more of a comparative clinical trial’s
researchers may have a decided treatment preference
based on their assessments of the evidence. But that is
no ethical bar to participation in the trial. The clinical
researchers must simply each recognize that their less-
  (55)   favored treatment is preferred by a sizable
constituency within the medical profession as a whole.    1 
 1. The author’s primary purpose in the passage is to

(A) explain the difference between two conceptions of an ethical standard together with how these conceptions would affect comparative clinical trials
(B) argue for a more reasonable, less restrictive interpretation of an ethical requirement than the one traditionally given by ethicists and physicians
(C) demonstrate that a change in the standards governing comparative clinical trials will endanger the ability of researchers to derive valuable information from such trials
(D) demonstrate the need for clinical researchers to more closely examine the conceptions embodied in the ethical standards to which these researchers adhere
(E) argue for a change in the scientific methods used for gathering evidence in comparative clinical trials

2 
 2. The primary purpose of the second paragraph of the passage is to

(A) provide a view that contrasts with arguments in favor of clinical equipoise
(B) explore the factors underlying physicians’ preferences regarding competing treatments
(C) undermine the moral principle that underlies the theory of theoretical equipoise
(D) state the main difficulty with adhering to the standards of theoretical equipoise
(E) illustrate the conflicts inherent in the general notion of equipoise

3 
 3. According to the passage, which one of the following is true?

(A) Comparative clinical trials that meet the standard of theoretical equipoise generally present no ethical problems.
(B) Clinical researchers are often forced to suspend comparative clinical trials prematurely because initial data from the trials strongly favors one treatment over another.
(C) A clinical trial comparing treatments is not rendered unethical merely because one of the participating physicians has come to favor one of the treatments over the other.
(D) A comparative clinical trial that meets the standard of clinical equipoise would therefore also meet the standard of theoretical equipoise.
(E) Medical researchers generally try to conduct comparative clinical trials in accordance with the standard of clinical equipoise.

4 
 4. Suppose two medical treatments are being compared in a clinical trial for their effectiveness in treating a condition. Based on the passage, which one of the following scenarios would be significantly more likely to jeopardize theoretical equipoise than clinical equipoise?

(A) The initial results of the trial so strikingly favored one treatment that they were published and widely disseminated before the study was even half over; as a result, most physicians who specialize in treating the condition came to favor the more effective treatment before the trial had ended.
(B) Preliminary results in the trial suggest that the two treatments are equally effective in treating the condition; but these results are not reported while the trial is underway and thus few in the expert clinical community are aware of them.
(C) Several of the physicians participating in the trial think that one treatment is more effective at treating the condition than the other; in this they agree with the consensus view within the expert clinical community.
(D) Initial results from the trial convince several of the participating physicians that one treatment more effectively treats the condition than the other does; this does not affect their recognition of the lack of consensus among experts in treating the disease.
(E) There is consensus among physicians participating in the trial that both treatments are equally effective at treating the condition; however, there is no consensus within the expert medical community as to the relative effectiveness of the treatments.

5 
 5. Which one of the following most accurately expresses the main point of the passage?

(A) The ethical requirement that physicians prescribe the best available treatment to their patients is jeopardized by an overly strict conception of equipoise.
(B) Medical research conducted through comparative clinical trials is able to achieve more if the ethical requirements it is bound by are not overly restrictive.
(C) It is sometimes ethically acceptable for a physician to participate in a clinical trial in which the physician has a decided treatment preference in favor of one of the treatments being tested.
(D) Clinical equipoise should be adopted because it is less likely to unreasonably constrict the conducting of comparative clinical trials than is theoretical equipoise.
(E) Even though comparative clinical trials often fail to meet the standard of theoretical equipoise, they should not, for that reason, be considered unethical.

6 
 6. As used in line 41 of the passage, the term “community" most nearly refers to a group of people

(A) who focus on a common set of problems using a shared body of knowledge
(B) who live and work in the same geographical area as one another
(C) who share opinions that differ significantly from those of other groups
(D) whose association with one another is based on their similar ethical values
(E) whose similar research methods are employed in unrelated disciplines

7 
 7. According to the passage, which one of the following is true?

(A) Most clinical trials that are conducted meet the appropriate ethical standards.
(B) Clinical trials would be conducted more often if there were a more reasonable ethical standard in place.
(C) Theoretical equipoise imposes an ethical standard on clinical trials that is rarely if ever met.
(D) Most physicians and ethicists believe that the currently accepted ethical requirements for comparative clinical trials are adequate.
(E) Most comparative clinical trials are undertaken to help resolve a conflict of opinion in the expert clinical community concerning the best available treatment.

8 
 8. The author’s argument in the third and fourth paragraphs would be most weakened if which one of the following were true?

(A) In most comparative clinical trials, the main purpose is to prove definitively that a treatment considered best by a consensus of relevant experts is in fact superior to the alternative being tested.
(B) Physicians participating in comparative clinical trials rarely ask to leave the trials because early data favors one of the treatments being tested over another.
(C) The number of comparative clinical trials that are conducted annually is increasing rapidly, but the level of ethical oversight of these trials is decreasing.
(D) Medical ethicists are more inclined than are clinical researchers to favor an ethical requirement based on theoretical equipoise over one based on clinical equipoise.
(E) In clinical trials comparing two treatments, it rarely occurs that researchers who begin the trial with no preference for either of the treatments later develop a strong preference on the basis of data obtained early in the study.

Sajjad1994 · Answer

Explanation

2. The primary purpose of the second paragraph of the passage is to

Explanation

The question asks for the primary purpose of the  second paragraph . The  second paragraph  suggests that the requirement of theoretical equipoise may be too strict because it is effectively an impossible standard for clinical trials to meet. Eliminate answers that contradict the Bottom Line or that are too narrow (i.e., that describe a purpose that is not the primary purpose of the second paragraph).

A. No.  This answer does not match the purpose of the second paragraph. The second paragraph does not provide a view that contrasts with the arguments in favor of clinical equipoise; instead, it provides reasons why theoretical equipoise may be too strict, thereby supporting the idea that clinical equipoise may be preferable.

B. No.  This answer does not match the purpose of the second paragraph. While the second paragraph does discuss the factors underlying physicians’ preferences regarding treatments, this is just a topic discussed in the second paragraph. The purpose of the second paragraph is to argue that the traditional conception of equipoise is too strict.

C. No.  This answer contradicts the Bottom Line. The passage does not disagree with the moral principle that underlies theoretical equipoise; rather, it suggests a new, less restrictive standard that would still achieve the same moral principle.

D. Yes.  This answer matches the purpose of the second paragraph. The second paragraph suggests that the requirement of theoretical equipoise may be too strict, because it is effectively an impossible standard for clinical trials to meet.

E. No.  This answer does not match the purpose of the second paragraph. The second paragraph does not criticize the general notion of equipoise; rather, it argues that the requirement of theoretical equipoise imposes standards that are virtually impossible for clinical trials to satisfy.

Answer: D

Sajjad1994 · Answer

Explanation

3. According to the passage, which one of the following is true?

Explanation

The question asks which answer is true according to statements in the passage. Since the answer could be supported from a statement located anywhere in the passage, look for a statement in the passage that would prove an answer choice true. Eliminate answers that contradict the Bottom Line or include strongly worded language or comparisons that are not supported by statements in the passage.

A. No.  This answer contradicts the Bottom Line of the passage. The passage argues that the requirements of theoretical equipoise are effectively impossible for clinical trials to satisfy.

B. No.  This answer goes beyond the passage. The passage does not discuss how often clinical researchers are forced to suspend trials in this manner.

C. Yes.  This answer is supported by a statement in the passage. In lines 50–53, the passage states that even if one or more researchers has a decided clinical preference as to treatment, this situation would be no ethical bar to participation in a trial, which implies that a physician holding such a preference would not render the clinical trial unethical.

D. No.  This answer contradicts the Bottom Line of the passage. The passage suggests that the standard of theoretical equipoise is too restrictive, and it proposes clinical equipoise as a less restrictive alternative; therefore, a clinical trial that meets the standard of clinical equipoise would not necessarily meet the standard of theoretical equipoise.

E. No.  This answer contradicts the Bottom Line of the passage. The passage suggests that theoretical equipoise is the traditional standard applied to clinical trials, and it argues that a new standard of clinical equipoise should be adopted. However, the passage does not state that researchers already do try to conduct trials in accordance with the clinical equipoise standard.

Answer: C

Sajjad1994 · Answer

Explanation

5. Which one of the following most accurately expresses the main point of the passage?

Explanation

Use the Bottom Line to choose an answer. Watch out for answers that are too narrow, go too far, or contradict the Bottom Line of the passage.

A. No.  This answer is too narrow. This is the main idea of the second paragraph only. It does not address the main ideas of the third and fourth paragraphs: that a new standard of clinical equipoise should be adopted instead.

B. No.  This answer does not match the Bottom Line. While the passage does say in the second paragraph that the conception of theoretical equipoise is almost impossible to satisfy, the passage goes on in the third and fourth paragraphs to propose a new standard that should be adopted.

C. No.  This answer is too narrow. This is the main idea of the fourth paragraph only. This answer does not address the main point, which is that the restrictive conception of theoretical equipoise should be replaced with the less restrictive conception of clinical equipoise.

D. Yes.  This answer matches the Bottom Line. The second paragraph argues that theoretical equipoise is too restrictive, and the third and fourth paragraphs argue that clinical equipoise is less restrictive and therefore should be adopted.

E. No.  This answer is too narrow. The passage argues that a clinical trial that does not meet the standard of theoretical equipoise but does meet the standard of clinical equipoise should not be considered unethical.

Answer: D

Sajjad1994 · Answer

Explanation

4. Suppose two medical treatments are being compared in a clinical trial for their effectiveness in treating a condition. Based on the passage, which one of the following scenarios would be significantly more likely to jeopardize theoretical equipoise than clinical equipoise?

Explanation

The question asks which answer would be significantly more likely to jeopardize theoretical equipoise than clinical equipoise. Look for an answer that describes a violation of the standard of theoretical equipoise but that would comply with the standard of clinical equipoise. According to the  second paragraph , theoretical equipoise requires that the researcher consider the evidence for the treatment regimens being compared to be exactly balanced. According to the  third paragraph , clinical equipoise provides that a researcher may prefer one treatment over another based on evidence, so long as clinical experts disagree as to which treatment is superior and the researcher recognizes this lack of consensus.

A. No.  This answer would not achieve the goal stated by the question. If, during a clinical trial, most clinical specialists came to favor one treatment over another, there would be no lack of consensus among medical experts, and therefore this scenario would violate the standard of clinical equipoise.

B. No.  This answer would not achieve the goal stated by the question. If preliminary results indicate that the two treatments are equally effective, then researchers participating in the study would have no reason to prefer one treatment over another, and this scenario would not jeopardize theoretical equipoise.

C. No.  This answer would not achieve the goal stated by the question. If physicians participating in the study prefer one treatment to another, then this scenario would jeopardize theoretical equipoise, but if there is no lack of consensus among clinical experts, then this scenario would also jeopardize clinical equipoise.

D.  Yes.   This answer achieves the goal stated by the question. If physicians participating in the study prefer one treatment to another, then this scenario would jeopardize theoretical equipoise, but if there is a lack of consensus among clinical experts and the physicians in question recognize this, then this scenario would not jeopardize clinical equipoise.

E. No.  This answer would not achieve the goal stated by the question. If physicians participating in the study believe both treatments are equally effective, then this scenario would not jeopardize theoretical equipoise.

Answer: D

Sajjad1994 · Answer

Explanation

7. According to the passage, which one of the following is true?

Explanation

The question asks which answer is true according to statements in the passage. Since the answer could be supported from a statement located anywhere in the passage, look for a statement in the passage that would prove an answer choice true. Eliminate answers that contradict the Bottom Line or include strongly worded language or comparisons that are not supported by statements in the passage.

A. No.  This answer contradicts the passage. The last sentence of the second paragraph of the passage states that few trials could comply with the standard of theoretical equipoise.

B. No.  This answer makes an unsupported comparison. The passage does not suggest that clinical trials would be conducted more often if a more reasonable standard were in place; rather, the passage suggests that more clinical trials would be able to satisfy that new standard than the current standard.

C.  Yes.   This answer is supported by a statement in the passage. The last sentence of the second paragraph of the passage states that few trials could comply with the standard of theoretical equipoise.

D. No.  This answer goes too far. While the last sentence of the first paragraph does state that most physicians and ethicists have traditionally agreed that traditional equipoise is appropriate for physicians in clinical trials, the passage does go so far as to state that most of them believe the currently accepted ethical requirements are adequate.

E. No.  This answer goes beyond the passage. While the third paragraph does discuss conflicts of opinion in the expert clinical community, the passage does not suggest that most comparative trials are undertaken to help resolve such conflicts of opinion.

Answer: C

ARSarkar · Answer

The passage says : 
 
.

That means as the study progresses and some evidences come that may tilt the balance , theoretical equipoise cannot be achieved. So option B tells the same thing. So why it is incorrect. Please explain.

Sajjad1994 · Answer

The difference between answer  choices (B)  and  (D)  is that in  (B) , preliminary results suggest that the treatments are equally effective but are not reported, while in  (D) , initial results convince some participating physicians that one treatment is more effective than the other. In  (B) , the lack of reporting may prevent the development of clinical equipoise, but in  (D) , the recognition of the lack of consensus among experts allows for the maintenance of clinical equipoise despite some researchers having a preference for one treatment over the other.

Sajjad1994 · Answer

Explanation

8. The author’s argument in the third and fourth paragraphs would be most weakened if which one of the following were true?

Explanation

The question asks which answer, if true, would most weaken the author’s argument in the third and fourth paragraphs. Treat this question the same as a Weaken question in the Arguments section. The author’s conclusion in the third and fourth paragraphs is that a new standard called  “clinical equipoise”  should be developed. The author supports this conclusion with the premise that a physician participating in a clinical study who develops a preference for one treatment over another should be allowed to continue to participate so long as a lack of consensus exists among clinical experts, and the physician acknowledges this lack of consensus. Look for an answer that suggests a problem with this plan to develop a new standard of clinical equipoise.

A.  Yes.   This answer weakens the argument in the third and fourth paragraphs. If most comparative clinical trials are undertaken to prove that a treatment considered best by a consensus of relevant experts is superior, then the standard of clinical equipoise would be jeopardized, because the standard of clinical equipoise requires that a lack of consensus exist among clinical experts as to which treatment is superior.

B. No.  This answer strengthens the argument. If physicians rarely ask to leave trials when they believe early data favors one treatment over another, then the study does not satisfy the requirement of theoretical equipoise. This supports the plan to develop a new standard of clinical equipoise that would allow those physicians to remain in the study so long as they acknowledge a lack of consensus among medical experts.

C. No.  This answer is irrelevant. The number of clinical trials being conducted annually does not affect the decision whether to develop a new standard of clinical equipoise.

D. No.  This answer is irrelevant. The opinion of medical ethicists compared with the opinion of clinical researchers is not relevant to whether a new standard clinical equipoise should be developed.

E. No.  This answer is not strong enough to weaken the argument. Even if it is rare that researchers begin a trial with no preference, then later develop a strong preference, the standard of clinical equipoise would still be needed to deal with such situations; furthermore, the standard of clinical equipoise would also still be needed to deal with other situations, such as allowing researchers to participate in a trial even if they begin the trial with a preference for one treatment over another.

Answer: A

nikitathegreat · Answer

GMATNinja  - Can you explain why Q2 option choice A is incorrect? Doesnt it provides a view that contrasts with the later paras?

2. The primary purpose of the second paragraph of the passage is to

(A) provide a view that contrasts with arguments in favor of clinical equipoise
(B) explore the factors underlying physicians’ preferences regarding competing treatments
(C) undermine the moral principle that underlies the theory of theoretical equipoise
(D) state the main difficulty with adhering to the standards of theoretical equipoise
(E) illustrate the conflicts inherent in the general notion of equipoise

@VeritasKarishma

GMATNinja · Answer

Question 2 
 
The point of the paragraph is that "clinical equipoise" is unworkable, which is why we need an alternative equipoise, one that's explored in the following paragraph. So it's actually expressing a view that's fully consistent with later paragraphs.

If the second paragraph had been about how awesome clinical equipoise was, well, THAT would contrast with ideas expressed later. But that's not what we get, so (A) is incorrect.

I hope that helps!

RenB · Answer

Hi  HarshR9 , can you please have a look at qs 3? I am not able to figure out why C is correct. I chose A, though I had a hunch that there is a possibility that though the trial may be ethical as per the considerations in this qs, the trial may be unethical due to other reasons. But couldntfigure out why C is correct thus chose A.

HarshavardhanR · Answer

Sure.

(C) A clinical trial comparing treatments is not rendered unethical merely because one of the participating physicians has come to favor one of the treatments over the other.

The logic you have presented contains the answer to your question.

I hope that it is clear (from the passage) that a clinical trial comparing treatments  could still be ethical  even if some of the participating physicians prefer one of the treatments. That is the crux of what "clinical equipoise" achieves - it is ok for doctors to have their own preferences and prescribe a treatment to a patient based on their preferences (accepted/establised vs. under test), as long as they acknowledge that the other treatment may also be preferred by a sizable chunk of doctors.

So, a clinical trial comparing treatments  could still be ethical  even if some of the participating physicians prefer one of the treatments.
Of course, a trial may still end up being unethical due to other reasons. No denying that.

BUT - choice C merely says -> a trial  does not become unethical because  a doctor favours one treatment over another. A trial could become unethical due to "n" other reasons. But the passage clearly suggests that a trial will not be considered unethical  for the reason that   a doctor favors one treatment over the other.

Hope the nuance here is clear!

Choice A is not really true. It actually goes against what the passage really says in my view. Theoretical equipoise creates an ethical conundrum which actually leads to a situation where few if any trials would ever get done.

"Consequently, if the standard of
(30) theoretical equipoise is adhered to, few comparative
clinical trials could commence and even fewer could
proceed to completion."

In other words, if theoretical equipose was adhered to, thanks to the ethics-related conundrums, few trials would even begin, very few would actually get done. Clearly, there are ethical problems being posed by theoretical equipoise here.

Cheers,
Harsha
Enthu about all things GMAT | Exploring the GMAT space | My website: gmatanchor.com

RenB · Answer

Hi  HarshR9 ,
Thank yo for the explanation.
For C, I thought, how do I know whether the option/ clinical trials considered are following the clinical equipose method? I thought that if the qs considers the theoretical equipose approach, then the option will be incorrect, if it follows clinical equipose, then yes, the option is correct.
Can you let me know where I am faltering here?

HarshavardhanR · Answer

Hi  RenB ,

Question Stem:  As per the passage (i.e., as per the author of the passage), what is true?

Important:  Statement C talks about something.

Given the author's statements on equipoise (theoretical, clinical, everything!) and everything else in the passage in fact, is that something true as per the author?   - this is what we should be determining here. We are not being asked if the statement is true for theoretical or if the statement is true for clinical or anything of this sort. We are being asked if the statement is true as per the passage overall, given the author's statements.

So, let's focus on what the author tells us.

What the author (passage) says -> 
Theoretical Equipoise -> is the  concept  of equipoise that is  typically considered  by people when thinking about equipoise. In other words, theoretical is what folks have in mind when they think of equipoise. As per the author, it is not practical. If it was properly applied, very few trials would actually happen. 
Clinical Equipoise -> is the concept of equipoise the author is trying to suggest as the one that is practical, and that  should be developed  in physicians, ethicists, etc.

-> As per the author, clinical equipoise is the correct equipoise.
-> And so, as per the author, it is pefectly fine  (i.e., still ethical)  if one or more of the physicians have a preference for one of the treatments over the other, as long as they acknowledge that the other treatment is also preferred by a sizable number of physicians.
-> And so, as per the author, a clinical trial comparing treatments is  not rendered unethical  merely because one of the participating physicians has come to favor one of the treatments over the other.

The author's view is clinical equipoise. So, what clinical equipoise suggests is what is true as per the passage here.

Hope this helps. 
___
Harsha
Enthu about all things GMAT | Exploring the GMAT space | My website: gmatanchor.com

VerbalBot · Answer

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Medical practitioners are ethically required to prescribe the best ava

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