When professional opinion is not enough

doi:10.1136/bmj.39161.403218.AD

BMJ 2007;334:831-832 (21 April), doi:10.1136/bmj.39161.403218.AD

Analysis

When professional opinion is not enough

Tom Treasure, professor of cardiothoracic surgery¹, Martin Utley, reader in operational research², Ian Hunt, specialist registrar in thoracic surgery¹

¹ Guy's Hospital, London SE1 9RT, ² Clinical Operational Research Unit, University College London, London

Correspondence to: T Treasure Tom.Treasure@ukgateway.net

Surgical resection of pulmonary metastases in patients withcolorectal cancer is common practice, but Tom Treasure, MartinUtley, and Ian Hunt question the strength of evidence behindadvice from NICE

The first 150 words of the full text of this article appear below.

New treatments are usually thoroughly evaluated before theyenter clinical practice, but much of what doctors do is basedon experience rather than evidence. However, just because apractice is widely accepted within the profession does not guaranteethat it is effective; there are many historical examples, suchas the practice of copious and repeated blood letting, whichpersisted from antiquity well into the mid-19th century.¹ Inrecognition of this, last year the UK National Institute forHealth and Clinical Excellence (NICE) launched an initiativeto identify interventions delivered by the NHS that do not benefitpatients.²

Of course, to reject the experience and insight of generationsof clinicians as "low grade evidence" and subject everythingwe do to randomised controlled trials would be hugely wastefuland impractical. Many existing practices should be retainedand new ideas introduced because the benefits are large andevident without further study.

The question . . . [Full text of this article]

Lung metastases from colorectal tumours

Knitting with sand

A way forward

Summary points

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This article has been cited by other articles:

Treasure, T. (2007). Editorial comment: Surgical resection of pulmonary metastases. Eur. J. Cardiothorac. Surg. 32: 354-355 [Full text]

Rapid Responses:

Read all Rapid Responses

When professional opinion is not enough: Alan Leaman
bmj.com, 24 Apr 2007 [Full text]
Resection of Pulmonary Metastasis in Colorectal Cancer; a known unknown clinical decision for the oncologist.: SWETHAJIT BISWAS
bmj.com, 24 Apr 2007 [Full text]
Professional opinion is not enough: Penella J Woll, et al.
bmj.com, 27 Apr 2007 [Full text]
When professional opinion is not enough: Graeme J Poston, et al.
bmj.com, 1 May 2007 [Full text]
Authors' reply: Tom Treasure, et al.
bmj.com, 8 Jun 2007 [Full text]