equipoise

[Cece]

Always good to learn a new word, especially one that supports the need to see CCSVI research done.

We thank Dr Reekers for his comments. We recognize and respect that differing views regarding the ethical permissibility of clinical research in CCSVI exist. As we stated, a strong scientific case has been made against CCSVI as a causative factor in multiple sclerosis, and we shared our doubt regarding its validity. Nonetheless, published clinical research suggests that endovascular intervention may be effective in at least a portion of involved patients. Therefore, we argue that a vital prerequisite for research to be conducted (ie, equipoise) exists. Equipoise in this instance is not an individual's sense of ambivalence regarding the efficacy of a novel treatment, but rather the existence of uncertainty within the scientific community regarding its efficacy compared with existing therapies or placebo.

http://archneur.jamanetwork.com/article ... id=1214757

CCSVI should be researched because equipoise exists.

Clinical equipoise, also known as the principle of equipoise, provides the ethical basis for medical research that involves assigning patients to different treatment arms of a clinical trial. The term was first used by Benjamin Freedman in 1987.

In short, clinical equipoise means that there is genuine uncertainty in the expert medical community over whether a treatment will be beneficial. This applies also for off-label treatments performed before or during their required clinical trials.

http://en.wikipedia.org/wiki/Clinical_equipoise

[EJC]

Splendid, thanks to Cece I am more intelligent this evening to the tune of one word.

I'll be looking for an opportunity to use it as soon as possible.

Keep up the good work!

We used to have a TV word game in the UK called "Call My Bluff" where the panelists would give three differing meanings of an obscure word each in an attempt to convince another team they were the correct definition. The job of the opposing team was to pick the correct one.

Equipoise would be absolutely perfect for Call my Bluff.

As you can see we really know how to live it up in the UK!

[Cece]

I would never have guessed the meaning of equipoise from the sound of the word itself. Equivalent and equine and poise would lead me astray.

[NHE]

http://www.thefreedictionary.com/Equipoise

e·qui·poise
n.
1. Equality in distribution, as of weight, relationship, or emotional forces; equilibrium.
2. A counterpoise; a counterbalance.

[1eye]

Well coming from a place concerned more about money than patients, it's a bottom-line kind of word. It has been used lately in discussions of the work of John Nash, who was a games theorist who won the Nobel for Economics. It is also used lately as the latest economics fad, and a couple of other Nobels have been won. See this reference.

Movie about Nash.

[Cece]

Interesting, 1eye, I missed that comment earlier.

I ran across 'equipoise' again. It might be relevant. ASTRAL was a renal artery stenting large randomized controlled trial.

ASTRAL has been criticized on a few fronts. First, the trial design is based on the “principle of equipoise”. Essentially, the investigators only enrolled patients in whom they were uncertain as to whether they would derive clinical benefit from revascularization. As such, many patients enrolled in the trial had lesions of dubious clinical significance, as more high-risk patients would not have been randomized. As an example, 40% of those enrolled had less than 70% stenosis, and some patients with stenoses as low as 60% were included.

http://renalfellow.blogspot.com/2009/11 ... trial.html
In any CCSVI trial, this might be relevant for patient selection.

[Cece]

http://www.medscape.com/viewarticle/829271

"Clinical equipoise requires that uncertainty exists about the efficacy of an intervention being studied in a clinical trial," they point out. "Since there is substantial evidence indicating that CCSVI is not a disorder and there is now a well-controlled double-blind clinical trial showing no benefit to venous angioplasty, there is no longer equipoise."

[MrSuccess]

.... and I'm still waiting for ANY clinical trial .... and the results.

There HAVE been " studies " that feature small enrollments . Including Dr.Zamboni's original 65 pwMS. Even Dr.Zamboni clearly stated that his work needs to be subjected to a LARGE clinical Trial conducted by his PEERS.

Small "studies" are helpful ...... but LARGE , Clinical Trials .... are better.

Six years out ...... and still no large Clinical Trials.

Now bear in mind , I have been on the road quite a bit lately . Did I miss something big ?


MrSuccess

[1eye]

Interesting, 1eye, I missed that comment earlier.

I ran across 'equipoise' again. It might be relevant. ASTRAL was a renal artery stenting large randomized controlled trial.

ASTRAL has been criticized on a few fronts. First, the trial design is based on the “principle of equipoise”. Essentially, the investigators only enrolled patients in whom they were uncertain as to whether they would derive clinical benefit from revascularization. As such, many patients enrolled in the trial had lesions of dubious clinical significance, as more high-risk patients would not have been randomized. As an example, 40% of those enrolled had less than 70% stenosis, and some patients with stenoses as low as 60% were included.

http://renalfellow.blogspot.com/2009/11 ... trial.html
In any CCSVI trial, this might be relevant for patient selection.

I agree! it should be relevant for patient selection in ANY trial. There has been much discussion in all kinds of contexts, of the definition, measurement and severity of stenosis.

Since the diameter --- caliber, radius, etc... choose your poison: they all mean various versions of the same thing --- affects the pressure, velocity, resistance, flow rate (volumetric or not) by its fourth power, THEREFORE, stenosis, lowering the diameter of a vessel, is the single most important and powerful way to reduce or obliterate the ability of that tubular structure to conduct fluids! If stenosis is measured by reduction in diameter, a 66 percent stenosis leads to a factor of 8 reduction in flow.