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Submitted by Steve on

The conversation here is very interesting, but it is impt to get the definition of equipoise right. The operational definition is not whether the researchers themselves are uncertain, but whether there is meaningful uncertainty, or observed variation, among the community of practitioners, which in this case might be the policy makers, and possibly researchers. Freedman's contribution was to eliminate the concept of individual researcher (or team) uncertainty from the mix, as long as there is meaningful disagreement in the community. Now, the second question is what is teh meaningful disagreement about? If it is about allocations of money to qualitatively different health interventions, then that should be the randomization, if indeed it is possible. If there is little doubt about the efficacy of a given allocation, or intervention, it probably shouldn't be randomized against not giving that intervention, although that depends on background conditions. Randomization to a suboptimal state can be justified depending on the counterfactual in that area. So this is indeed a complicated question, and parallels w/medicine aren't perfect. There is something to be learned from the thinking that has gone on in medicine, but it has to be correctly framed. But the better medical parallel to development is the area of systems or quality improvement, which even in medicine can be very context-dependent.