Clinical equipoise and the uncertainty principles both require further scrutiny

EDITOR—The exchange between Weijer et al and Enkin addresses the question of under what circumstances and for what reasons entering patients in clinical trials can be morally justified.1 It is important to see, however, that the issues are a good deal more complicated. There are problems on both sides, but I will focus on clinical equipoise.

This concept inadvertently conflates two distinct concepts, and neither one provides a convincing resolution of the moral dilemma posed by clinical trials. 2 3 Most of the essay by Weijer et al focuses on just one of these, which should really be termed “community equipoise” (the situation where not all within the community of “experts” have come to agreement that one treatment is superior to another). Enkin raises one problem with this criterion: that it fails to take seriously the clinical and moral judgment of the individual physician. But a closer look at community equipoise shows in addition that, once we understand that a policy decision (to stop the trial, announce the results, approve the drug, etc) requires a greater amount of evidence than does an individual decision to choose what is best for one's …