Equipoise bioethics

When may a physician legitimately offer enrollment in a randomized clinical trial (RCT) to her patient? Two answers to this question have had a profound impact on the research ethics literature. Equipoise, as originated by Charles Fried, which we term Fried's equipoise (FE), stipulates that a physician may offer trial enrollment to her patient only when the physician is genuinely uncertain as to the preferred treatment. Clinical equipoise (CE), originated by Benjamin Freedman, requires that there exist a state of honest, professional disagreement in the community of expert practitioners as to the preferred treatment. FE and CE are widely understood as competing concepts. We argue that FE and CE offer separable and, in themselves, incomplete justifications for the conduct of clinical trials. FE articulates conditions under which the fiduciary duties of physician to patient may be upheld in the conduct of research. CE sets out a standard for the social approval of research by institutional review boards. Viewed in this way, FE and CE are not necessarily competing notions, but rather address complementary moral concerns.

Unlike the other major philosophical lights of his era, and despite having written more than any of them, Leibniz produced no magnum opus . He seemed most at home in dialogue, in correspondence, and in controversy. The Discourse on Metaphysics and Monadology are his most commonly studied works in metaphysics. Scholars disagree about the extent to which the two works are in accord, but they together provide a solid grounding in Leibniz’s thought. The Theodicy is a classic of philosophical theology and the New Essays provides the fullest account of Leibniz’s epistemology. This article will summarize Leibniz’s philosophy mainly as it is presented in these works. It would be a mistake, however, to think that one can get a full picture of Leibniz’s interests from these works and the reader is encouraged to consult the many excellent edited selections of Leibniz’s texts.

Goethe’s way of reading was neither that of the scholar seeking out arguments to analyze nor that of the historian curious about the ideas of the great minds. No disciple of any particular philosopher or system, he instead borrows in a syncretic way from a number of different and even opposing thought systems in the construction of his Weltanschauung . And whenever particular subjects could not be put to practical use, Goethe’s attention quickly moved on. In a rather telling recollection, Goethe characterizes his philosophy lectures thusly, “At first I attended my lectures assiduously and faithfully, but the philosophy would not enlighten me at all. In logic it seemed strange to me that I had so to tear asunder, isolate, and, as it were, destroy, those operations of the mind which I had performed with the greatest ease from my youth upwards, and this in order to see into the right use of them. Of the thing itself, of the world, and of God, I thought I knew about as much as the professor himself; and, in more places than one, the affair seemed to me to come into a tremendous strait. Yet all went on in tolerable order till towards Shrovetide, when, in the neighborhood of Professor Winkler's house on the Thomas Place, the most delicious fritters came hot out of the pan just at the hour of lecture,” (Goethe 1902, 205). Philosophy apparently held just slightly less interest than good pastry. Notwithstanding this estimation, indelible philosophical influences are nevertheless discernible.

"Holistic Biology ...  Philosophy Now #122 In recent years biology has been moving beyond a biochemically reductive view of life. The days when we could regard ourselves as lumbering robots for our genes, to recall Richard Dawkins’ resonate phrase, are numbered, if not already over. Life for the biologist has become a lot more complex, and arguably, in its intricacy, more beautiful...  I recently attended a conference on what is sometimes called ‘holistic biology’ or the ‘extended evolutionary synthesis’...  These developments have led the philosopher Michael Ruse to pose a fundamental question. In biology, there has long been two ways of looking at life: as a mechanism, which can be broken down into parts; and as an organism, which can be explained only by considering the way the whole system works. Organicism is the more ancient approach, while the machine metaphor has come to dominate in modern times. Ruse suggests that perhaps it’s time for organicism to make a comeback.  Its origins reach all the way back to Plato." . The links here provide access to one of four complimentary articles for non-subscribers.

Vernon, M. Rediscovering Plato's Vision .  Philosophy Now . Issue 122. Oct/Nov 2017. -8.

Mark Vernon is the author of  The Idler Guide to Ancient Philosophy  (Idler Books, 2015).
For more, see  .

The equipoise requirement in clinical research demands that, if patients are to be randomly assigned to one of two interventions in a clinical trial, there must be genuine doubt about which is better. This reflects the traditional view that physicians must never knowingly compromise the care of their patients, even for the sake of future patients. Equipoise has proven to be deeply problematic, especially in the Third World. Some recent critics have argued against equipoise on the grounds that clinical research is fundamentally distinct from clinical care, and thus should be governed by different norms. I argue against this �difference position,� and instead take issue with the traditional, exclusively patient-centered account of physicians’ obligations that equipoise presupposes. In place of this traditional view, I propose a Kantian test for the reasonable partiality that physicians should show their patients, focusing on its application in clinical research and medical education.

Look up the history of the anthrax vaccine. The development of the polio vaccine was the beginning of everything that was to become totally wrong about vaccine development, vaccine policy and vaccine politics (we call it Political Immunology). Look at the history of the MMR vaccine, where earlier versions caused meningitis outbreaks but the vaccine was still licensed for use, and in some countries like the UK it became licensed even *after* the meningitis risk was known. Even after it was pulled from use in the UK it was then sent to developing countries…no reason to waste perfectly good product! Even our current MMR vaccine is under scrutiny as Merck is fighting a lawsuit from two whistleblowers who are claiming that they were asked to falsify clinical trials data in order to make the mumps portion of the vaccine appear to be more effective.

Equipoise bioethics

equipoise bioethics

"Holistic Biology ...  Philosophy Now #122 In recent years biology has been moving beyond a biochemically reductive view of life. The days when we could regard ourselves as lumbering robots for our genes, to recall Richard Dawkins’ resonate phrase, are numbered, if not already over. Life for the biologist has become a lot more complex, and arguably, in its intricacy, more beautiful. ...  I recently attended a conference on what is sometimes called ‘holistic biology’ or the ‘extended evolutionary synthesis’. ...  These developments have led the philosopher Michael Ruse to pose a fundamental question. In biology, there has long been two ways of looking at life: as a mechanism, which can be broken down into parts; and as an organism, which can be explained only by considering the way the whole system works. Organicism is the more ancient approach, while the machine metaphor has come to dominate in modern times. Ruse suggests that perhaps it’s time for organicism to make a comeback.  Its origins reach all the way back to Plato." . The links here provide access to one of four complimentary articles for non-subscribers.

Vernon, M. Rediscovering Plato's Vision .  Philosophy Now . Issue 122. Oct/Nov 2017. -8.

Mark Vernon is the author of  The Idler Guide to Ancient Philosophy  (Idler Books, 2015).
For more, see  .

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