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closeBaffling the principle of equipoise
Posted by Paul_Vaucher on 11 Jun 2009 at 08:30 GMT
Lavery et al have proposed a new concept for stopping trials related to "opportunity costs". This procedure is meant to distribute resources "wisely" to trials for which "we" hope more promising results. The problem with this proposal is it makes phase III clinical trials senseless. If we can truly consider that it is possible to put up a procedure to judge an intervention as more promising one than another, why bother wasting resources on expensive, time consuming trials to show the same thing?
With this proposal, Lavery et al have hit the cornerstone of clinical trials: the principle of equipoise. Assuming we do not know if an intervention is beneficial is not only ethically indispensable, but it is the basis of hypothesis testing.
Opportunity costs is nevertheless an important issue on how to wisely distribute resources. Peer reviewing protocols by experts before starting trials could help accord funds for trials with up to date innovations. We should also take the time to develop interventions before testing them. Secrecy related to concurrence between developers and financial expectations from marketing are limitations to both these procedures. The “opportunity cost” stopping rule could be focusing on the wrong target to limit research costs.