Short Answer Case Study (Bioethics class)
Question: (please answer after reading the case)
How might equipoise become an ethical issue during thedrug trial that Dr. Kimball is conducting ( 2 points)
Upon inspecting his schedule for the day, psychiatrist DavidKimball was surprised to learn that his first patient of themorning was Geoffrey Allen. Geoff had been in for an appointmentless than 2 weeks ago to discuss his response to a monoamineoxidase inhibitor (MAOI) as a treatment for chronic depression. Atthe time, it seemed as though the medication was working, a relieffor both Geoff and Dr. Kimball after several years of searching forthe right way to manage Geoff’s illness. Geoff had been referred toDr. Kimball’s practice by Student Health during his freshman year.After discussing Geoff’s symptoms of insomnia, lethargy, and weightloss as well as learning of a family history of depressivedisorders, Dr. Kimball prescribed the first of what would be a longlist of medications. Through the course of his magna cume laudedegree in political science and now into his doctoral dissertation,Geoff had tried several tricyclic antidepressants, selectiveserotonin reuptake inhibitors, and second-generationantidepressants. While he would have periods of stability rangingfrom a few weeks to a few months as in the case of fluoxetine,eventually either the medication stopped working or the sideeffects became too bothersome. At his last appointment, Dr. Kimballhad been pleased with Geoff’s clinical response to the MAOI, eventhough a brief physical examm revealed the presence of mildorthostatic hypotension. When queried, Geoff himself said he feltbetter than he had in months with the exception of the fact that heand his girlfriend were less than thrilled about the side effects.In response, Dr. Kimball adjusted the prescription and remindedGeoff not to hesitate to schedule another appointment if thingschanged. “Well, you’re always reminding me to come to see you ifsomething comes up,” Geoff said when Dr. Kimball asked about thepurpose of Geoff’s visit, “and there’s something I need to talkabout. I’m starting to feel tired again like I have no energy, andmy motivation to do things is slipping. My girlfriend is telling methat things have to change or she is going to leave me.” Geoff wenton to describe an elevation in his depressive symptoms as well as agrowing dissatisfaction with the MAOI side effects. Dr. Kimball iscurrently conducting a Phase III drug trial for a drug called Licol, a new lithium-based antidepressant, which has shown great promisefor the treatment of atypical depression, especially in youngeradults. However, these clinical trials for the medication utilizeddouble-blind placebo controls. Also, data was not yet availableconcerning the follow-up treatment of patients who withdrew fromthe trials. Dr. Kimball thinks that Geoff would be a goodparticipant in this study and is considering talking to Geoff aboutbecoming a participant.
