Hostname: page-component-78c5997874-4rdpn Total loading time: 0 Render date: 2024-11-15T08:44:11.230Z Has data issue: false hasContentIssue false
  • English
  • Français

Limitations of Nonscience in Surgical Epistemology: The Second-Look Laparotomy

Published online by Cambridge University Press:  10 March 2009

Michael Baum
Michael Baum
Affiliation:
King's College School of Medicine and Dentistry, Rayne Institute
Get access Rights & Permissions [Opens in a new window]

Extract

Decision-making in medicine is a very complex process that demands input both from the doctor and from the client. From the doctor's point of view, the most important component for this decision concerns the quality of evidence available that the recommended intervention is the best available in terms of both cost and benefit. Good quality evidence demands good quality science. The randomized controlled trial is the expression of this scientific process at work within medical practice. This article reviews both the rationale and the ethics of randomized controlled trials in the epistemology of surgery. The ethical dilemma is accentuated because surgery by its very nature is invasive and often irreversible. As an illustration of the scientific and ethical dilemmas arising out of randomized controlled trials in surgery, a description of the CEA directed second-look laparotomy trial in the United Kingdom is provided. This trial may be judged essential because of the clash of attitudes between surgeons in the United States and the United Kingdom. It is unlikely that the truth lies entirely with one or other national groupings of surgeons, and this randomized trial will eventually resolve a conflict of ideas to the ultimate benefit of all patients with operable colorectal cancer.

Type
Special Section: Technology Assessment and Surgical Policy
Information
International Journal of Technology Assessment in Health Care , Volume 5 , Issue 3 , July 1989 , pp. 381 - 388
Copyright
Copyright © Cambridge University Press 1989

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Bacon, H. E., & Berkley, J. L.The rationale of re-resection for recurrent cancer of the colon and rectum. Diseases of the Colon & Rectum, 1959, 2, 549–54.CrossRefGoogle ScholarPubMed
Baum, M.Do we need informed consent? Lancet, 1986, 2, 911–12.Google Scholar
Baum, M.Quack cancer cures or scientific remedies? Clinical Oncology, 1983, 9, 275–80.Google ScholarPubMed
Brahams, D.Clinical trials and the consent of the patient. Practitioner, 1982, 226, 1829–30.Google ScholarPubMed
Cochrane, J. P. S., Williams, J. T., Faber, R. G., & Slack, W. W.Value of outpatient follow-up after curative surgery for carcinoma of the large bowel. British Medical Journal, 1980, 280, 593–95.Google Scholar
Faulder, C., Peckham, M. J., Baum, M., Bullimore, J. A., Cuzick, J., Durrant, K. R., Maguire, G. P., Sloane, J., Teasdale, C., Tobias, J. S., & White, H.Informed consent: Ethical, legal, and medical implications for doctors and patients who participate in randomised clinical trials. British Medical Journal, 1983, 286, 1117–21.Google Scholar
Gill, P. G., & Morris, P. J.The survival of patients with colorectal cancer treated in regional hospital. British Journal of Surgery, 1978, 65, 17–20.Google Scholar
Goligher, J. C.Surgery of the anus, rectum and colon, 4th Edition. London: Bailliére Tindall, 1980.Google Scholar
Kuhn, T. S.The structure of scientific revolutions. Chicago: University of Chicago Press, 1970.Google Scholar
Martin, E. W., Cooperman, M., Carey, L. C., & Minton, J. P.Sixty second-look procedures indicated primary by rise in serial carcinoembryonic antigen. Journal of Surgical Research, 1980, 28, 389–94.CrossRefGoogle Scholar
Meeker, W. R.The use and abuse of CEA test in clinical practice. Cancer, 1978, 41, 854–62.Google Scholar
Moertel, C. G., Shutt, A. J., & Go, V. L. W.Carcinoembryonic antigen test for recurrent colorectal carcinoma. Journal of American Medical Association, 1978, 239, 1065–66.CrossRefGoogle ScholarPubMed
Nicholson, J. R., & Aust, J. C.Rising carcinoembryonic antigen titers in colorectal carcinoma: An indication for the second-look procedure. Diseases of the Colon and Rectum, 1978, 21, 163–64.Google Scholar
National Institutes of Health Consensus Statement. Carcinoembryonic antigen: Its role as a marker in the management of cancer. British Medical Journal, 1981, 282, 373–75.CrossRefGoogle Scholar
Polk, H. C., & Spratt, J. S. Recurrent colorectal carcinoma: Detection, treatment and other considerations. Surgery, 1971, 9–25.Google Scholar
Popper, K. R.The logic of scientific discovery. London: Hutchinson, 1959.Google Scholar
Skrabanek, P.Paranormal health claims. Experientia, 1988, 44, 303–09.Google Scholar
Slaney, G.Results of treatment of carcinoma of the colon and rectum. In Irvine, W. T., (Ed.), Modern trends in surgery, Vol. 3. 1971, 66–89.Google Scholar
Staab, H. J., Anderer, F. A., Stumpf, E., & Fischer, R.Carcinoembryonic antigen follow-up and selection of patients for second-look operation in management of gastric intestinal carcinoma. Journal of Surgical Oncology, 1978, 10, 273–82.Google Scholar
Taylor, I., Machin, D., Mullee, M. et al. A randomized controlled trial of adjuvant portal vein profusion in colorectal cancer. British Journal of Surgery, 1985, 72, 359–63.Google Scholar
Wangensteen, O. H., Lewis, F. J., Arhelger, S. W., Muller, J. J., & MacLean, L. D.An interim report upon the “second look” procedure for cancer of the stomach, colon and rectum and for “limited” intraperitoneal carcinosis. Surgery Gyneacology & Obstetrics, 1954, 99, 257–67.Google ScholarPubMed
Yusuf, S., Collins, R., & Peto, R.Why do we need some large, simple randomized trials? Statistics in Medicine, 1984, 3, 409-24.CrossRefGoogle ScholarPubMed