New oncology trial designs and equipoise: Commentary on Heynemann et al.

This essay responds to Heymemann et al.'s analysis of the applicability of clinical equipoise to emerging trial methods in cancer. Briefly, I argue that equipoise presses study designers to conduct trials at the point of maximum community uncertainty. Accordingly, equipoise encourages maximum information gain per patient enrolled (or inversel, minimal patient burden per gain in information). As such, equipoise is as much a condition for the ethical conduct of new study designs as it is for old ones. I close by suggesting that, whereas Heymemann et al. suggest new trial designs present a challenge to the operationalization of equipoise, I argue that equipoise presents a challenge for those wishing to operationalize new trial designs.