In the face of novel pathogens, incomplete knowledge, and disagreement about the merits of medical treatments, translating the duty to care into concrete benefits for patients depends on our ability to quickly act on the duty to learn. Learning is a dynamic process whose goal, in medical research, is to generate the evidence needed to reduce uncertainty and shift care toward safer, more effective, and efficient practice. It is also a social process that requires the cooperation of multiple stakeholders, including funders, researchers, health care professionals, health systems, regulatory bodies, and patients. The interests of these stakeholders can conflict, and the requirement of clinical equipoise is seen as a way to ensure that research promotes medical progress without compromising the interests of study participants. The equipoise requirement holds that (1) research that addresses uncertainty or conflicting medical judgments of conscientious and informed experts is likely to have social value and (2) allocating individuals to interventions that are subject to such conflict or uncertainty is consistent with respect for their rights or welfare. But when does clinical equipoise no longer hold?
Source: JAMA Online First