On Thu, 2 Sep 1999 20:16:04 +0930 you said:
>Hi Everyone,
>Thankyou to those who replied to my query about using a postmodern =
>approach to assessing evidence for determination of equipoise. Useful =
>information included:
>If what you are saying is that evidence can be used however a researcher =
>wants in order to promote the idea that there is genuine equipoise and =
>the need for a trial, then a systemmatic review is needed [see recent =
>e-b-h correspondence] to reflect "all the evidence" determined by =
>different people in various contexts.
I would add to this. Another way to look at equipoise is from the
standpoint of judgment and decision psychology. There is now a large
and interesting literature about how people, including physicians, make
judgments and decisions. Judging equipoise is a kind of probabilistic
judgment. It requires judging the rates of important outcomes due to
treatments x and y, and deciding whether they are similar. Presumably
the optimal way to make these judgments is to do a systematic, critical
review of the relevant clinical literature.
>"If you look at the literature on equipoise it pretty much deconstructs =
>itself" [I like that one! No need for postmodernist critique here] Also =
>referred me to the writings of Nick Fox and Richard Ashcroft.
It may be post-modernist, if by "post-modernist" you mean opaque. What does
this mean?
>R. Ashcroft: "Equipoise justifications of trials turn on socially =
>controlled and negotiated judgments of epistemic indifference."
See above comment. Can you translate this into English?
>N. Fox: "Medicine, psychiatry, sex therapy and other caring disciplines =
>construct human subjects in ways which supercede earlier versions, not =
>for reasons of rationality, but for strategic objectives concerned with =
>power and control."
And I suppose we doctors construct patients like Dr.Frankenstein constructed
his creation? And after extensive socialization and swearing an oath to
do the best for my individual patients, I resent having my work characterized
as being mainly concerned with power and control.
Roy M. Poses MD
Director of Research, General Internal Medicine
Brown University Center for Primary Care and Prevention
Memorial Hospital of Rhode Island
111 Brewster St.
Pawtucket RI 02860 USA
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