LSAT 72, RC Passage 3, Equipoise, LSATHacks

This is an explanation for passage 3 of LSAT preptest 72, the June 2014 LSAT. This passage is about how the ethical concept of equipoise can unduly restrict drug research. The passage proposes the use of “clinical” equipoise to allow researchers to ethically test new drugs.

This section has paragraph summaries and an analysis of the passage, links to the explanations for the questions are below.

Paragraph Summaries

1. There is a contradiction between the ethical requirement to provide the best treatment, and the research requirement to have no opinion about the best treatment. (Equipoise)
2. “Theoretical” equipoise is too strict. It requires clinicians to have no preference for one of two treatments. This is almost impossible.
3. “Clinical” equipoise is more realistic. Clinicians can ethically participate in a study if the research community is split on what drug may be more effective.
4. Divided opinion about the effects of drugs is what makes clinical equipoise ethically possible.

Analysis

This is the hardest passage on the test. Equipoise is not a word you hear most days. I took this opportunity to look it up:

Equipoise: balance of forces or interests

In other words, ethics requires researchers to believe  that both treatments have an equal chance of succeeding. 

Before I explain the passage, I want to talk a bit about science. The LSAT expects you to have two kinds of scientific knowledge:

1. An understanding of how experiments work.
2. A basic background knowledge of scientific material that prevents your head from spinning when you read science passages and LR science questions.

Technically, the second kind of knowledge isn’t essential. You don’t need subject matter knowledge to get LSAT questions right. But oh how it helps! The LSAT is based on real world situations, and subject knowledge is incredibly useful. 

I actually find science passages are easier than average (even this one wasn’t bad) because I have a good baseline amount of scientific knowledge.

To improve both types of scientific knowledge, I recommend reading the science section of the Economist. It talks about scientific topics in a way that’s not dumbed down, and yet makes sense for a non-scientist. 

Go to your local library, and get 20-30 back issues of the Economist. I say 20-30 because the science section is small – each issue only has 2-3 pages. 

Also, get the print magazine. Don’t read it online. For two reasons. First, the LSAT is in print, so it’s better to match the format. Second, the Economist website has many blog posts. These don’t have the same style as the science articles in the print magazine, which are better for our purposes.

Once you read a sufficient amount of scientific material, you will have a better scientific background and you’ll be able to understand what’s going on in science passages. You’ll also gain an intuition for how experiments are supposed to work.

How equipoise affects experiments

Now, to the passage itself. I’m going explain it with an example. I’ll talk about HIV and anti-retrovirals. HIV is, of course, the horrible, currently incurable disease that leads to AIDS.

We don’t know how to cure HIV. But we currently can manage it with anti-retrovirals. As far as we know, these are the best treatment option for HIV.

But surely there may be a better option. For instance, maybe a new type of drug will prevent HIV turning into AIDS, with fewer side effects than anti-retrovirals (I’m assuming they have some side effects, most drugs do). Or maybe another drug will cure HIV entirely.

So, we want to be able to test new drugs to see if they are better than anti-retrovirals. But, the problem here is that there is a conflict between these two ethical standards:

1. Doctors should prescribe the best treatment.
2. Professionals conducting experiments should be neutral about the likely results of the experiment.

Currently, professionals believe that anti-retrovirals are the best treatment. So they’re ethically obligated to prescribe then. But this makes it very hard to be neutral about which treatment will be best – the medical community will tend to favor anti-retrovirals. It’s hard to be neutral about a new treatment when that treatment doesn’t have the same number of studies that anti-retrovirals do.

Now, theoretical equipoise does have some uses. It rightly prevents doctors from testing good solutions against alternatives that everyone expects will be useless. For instance, it is rightly ethically impossible to conduct an experiment that compares anti-retrovirals and salt as cures for HIV. No one believes salt cures HIV (I think). So it would be grossly unethical to deny half of the experiment access to life saving drugs in order to measure the difference between anti-retrovirals and salt.

How clinical equipoise can help

That’s clear. But what if there was a trial between anti-retrovirals and a promising but unproven drug? Most doctors would think that anti-retrovirals are a better treatment, until they see evidence. But they can only get evidence by doing a study.

Under current ethical standards, it’s very hard to do a new study. If the doctors think the new drug is unlikely to be better, it’s unethical to prescribe it to half of the experiment, even if it’s less unethical than prescribing something obviously useless (such as salt). 

If doctors are required to be strictly neutral when conducting an experiment (theoretical equipoise) then it’s almost impossible to test new drugs. the new drugs might be better, but at the time the experiment starts no reasonable doctor would believe that.

That’s why the author proposes a new standard: clinical equipoise. This allows researchers to ethically test two drugs if at least some part of the medical community believes each drug is effective.

So we might have a case where 95% of a community thinks anti-retrovirals are best, but 5% of the community thinks that the new drug is better. In that case, researchers could ethically test both drugs, since there is some support for favoring the new drug.

Note that this only works for new drugs that have some support. If a new drug has some promise, but no part of the medical community thinks it is best, then even clinical equipoise won’t let researchers ethically prescribe the new drug.

Note that “community” refers to a specific group of doctors and researchers who are experts about a given type of drug or disease. One of the questions asks about this.

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