Podsećanje na borbu za uvođenje kontrolisanih kliničkih studija u cilju optimalnog izbora hirurškog lečenja karcinoma dojke

This paper examines the debates within medical practice as more sophisticated statistical techniques became available for evaluating the best surgical technique for the treatment of breast cancer. On the other hand, Halsted radical mastectomy advocates, accustomed to making treatment decisions based on personal experience, argued that randomized controlled trials would sacrifice lives to prove that they already knew. By reviewing how the critics and supporters of the randomized controlled trials attempted to prove the superiority of their methodologies, this paper demonstrates the uses of rhetoric in the construction of scientific knowledge. Radical mastectomy had also come to symbolize how surgeons acquired knowledge about therapeutic interventions. On the surface, the debates over randomized controlled trials for radical mastectomy appeared to be a sincere disagreement over competing methodologies. But the assertions of randomized controlled trials foes were inextricably linked to issues of prestige and professionalism. The impasse was finally resolved by surgeon Bernard Fisher - he had developed a biologically-based alternative that the most breast cancers spread throughout the body early in their course. Fisher’s theories explained why more aggressive local surgery appeared to have little effect on an overall survival. The combination of the multiple retrospective case studies plus his laboratory findings might have convinced Fisher that radical mastectomy was no longer necessary. Ultimately, Fisher successfully produced the type of statistical information-data from randomized controlled trials - that had become increasingly necessary to demonstrate whether or not a given therapeutic intervention had value. Exponential grow of randomized controlled trials required formulating evidence-base medicine, as a leading principle in guideline development for treatment