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The Belmont Report addresses the distinction between practice and research as guidance for which activities should be evaluated prospectively by a research ethics committee. This essay argues that the distinction between clinical practice and clinical research has a more fundamental significance for understanding the ethics of clinical research. After discussing the important connections between clinical research and clinical practice, the essay examines in detail ethically significant differences between these two sorts of activities. This sets the stage for a critique of clinical equipoise, widely regarded as a fundamental principle of clinical research ethics.