Equipoise
The concept of equipoise is pretty central to every decision we make and yet I have not heard this concept mentioned a single time during the coronavirus pandemic.
Formal Definition of Clinical Equipoise: The assumption that there is not one ‘better’ intervention present for either the control (practice) or experimental group (theory) during the design of a randomized controlled trial. The state of equipoise exists when one has no good basis for a choice between two or more care options. (Cook and Sheets)
The basic concept works like this: you have a problem or disease with no clear superior treatment options. Let’s use the coronavirus as an example and work from the macro to the micro level. From a public health standpoint let’s look at the concept of social distancing. Covid 19 is a new virus and thus there you have to use a surrogate virus/viruses to look at the efficacy of social distancing during past pandemics. Using the search terms “social distancing” + virus in pubmed we find the oldest article is from 2005 which was published in Nature. Nature is an important journal and this article basically stated that social distancing combined with vaccines and not very contagious virus (R0<1.8) could be an effective strategy at containment (1). Crawling forward to 2020 through the literature lends zero support for crushing the world economy over a highly contagious virus with no vaccine, that primarily hospitalizes and kills elderly people with multiple medical comorbidities. Fortunately, the coronavirus medical ‘experts’ sway is weakening as everyone realizes the reality of the response.
Working from the macro level down to the individual level you can go on quite a journey.
Social Distancing
Resource utilization
ECMO
Plaquenil and remdesivir
Face mask
Opening restaurants at 1/2 capacity
You can make a pretty endless list
My big hope is that science, logic, and reason will prevail at the end of this pandemic and for all future pandemics.
What health, fitness, and even financial decisions do you have equipoise for the path you are on versus the alternatives?
Citations:
1) Ferguson, N., Cummings, D., Cauchemez, S. et al. Strategies for containing an emerging influenza pandemic in Southeast Asia. Nature 437, 209–214 (2005). https://doi.org/10.1038/nature04017