Education And Debate

Controversies in Management: Commentary: caution still needed

BMJ 1995; 310 doi: (Published 28 January 1995) Cite this as: BMJ 1995;310:248
  1. Peter C Rubin

    For the last eight years I have been on the steering group of an international trial evaluating a treatment which in small numbers of highly selected patients seemed almost too good to be true. It was. Tested in a large number of relatively unselected people the drug showed no significant effect on outcome. I sense something of the same here in the debate over chemotherapy for solid tumours. Doctors advising patients with these tumours have the added burden that people who are facing death will clutch at poorly documented straws—fed to them by an eager and sometimes uncritical media—rather than wait for well designed linical trials of high statistical power. The data on Dukes's B and C of the colon are persuasive. However, in most other sorts of solid tumour there seems little at present to justify widespread use of chemotherapy.—PETER C RUBIN, professor of therapeutics, University of Nottingham

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