Consider the following paragraphs drawn from “New Drugs Stir Debate on Rules of Clinical Trials” http://www.nytimes.com/2010/09/19/health/research/19trial.html

[W]hen Mr. Ryan, 22, was admitted to the trial in May, he was assigned by a computer lottery to what is known as the control arm. Instead of the pills, he was to get infusions of the chemotherapy drug that has been the notoriously ineffective recourse in treating melanoma for 30 years.

“I’m very sorry,” Dr. Bartosz Chmielowski, the U.C.L.A. oncologist treating both cousins, told Mr. Ryan’s mother, Jan. He sounded so miserable that afternoon that Mrs. Ryan, distraught, remembers pausing to feel sorry for the doctor.

Defenders of controlled trials say they are crucial in determining whether a drug really does extend life more than competing treatments. Without the hard proof the trials can provide, doctors are left to prescribe unsubstantiated hope — and an overstretched health care system is left to pay for it. In melanoma, in particular, no drug that looked promising in early trials had ever turned out to prolong lives.

PLX4032 [the experimental treatment] shrinks tumors in the right patients, for a limited time. But would those who took it live longer? No one knew for sure.

And doctors say that for them, the new wave of cancer drugs is intensifying the conflict between their responsibility to their patients and their commitment to gathering scientific knowledge for generations of the critically ill.

Dr. Bartosz Chmielowski, who treated the two cousins, obeys trial protocols but says withholding a drug from a patient he thinks could be helped “is awful.”

Please use the passage to construct an essay (600-900 words) that accomplishes the following tasks.

Explain the conflict alluded to involving the competing role-driven obligations of doctors involved with RCTs such as the cancer trial discussed in the passage.

Explain the distinction between theoretical and clinical equipoise.

Explain whether Dr. Chmielowski could employ either notion of equipoise to justify his adherence to trial protocols.

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