Equipoise and the Dilemma of Randomized Clinical Trials

To the Editor: In stating that “proponents of equipoise have characterized randomized clinical trials solely as tools to guide clinicians in making decisions about optimal medical care,” Miller and Joffe (Feb. 3 issue)¹ misrepresent the concept of equipoise. Equipoise motivates clinical experts to propose randomized, controlled trials to resolve uncertainties about the relative merits of interventions and affirms the ethical propriety of participating clinicians' subsequent offer of trial enrollment to particular patients as “best therapy.”^2,3 If the offer is to be cast as a “therapeutic orientation” to clinical research, it should be encouraged.In selecting the encouraging response rates . . .