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—The letters by Dr Cocconi, Mr Klaff, and Dr Yun Ryo allow us to clarify some relevant issues and implications of our trial. Concern is expressed on the applicability of our results to the care of individual patients. We believe that the results of clinical trials should be the best guide to physician's behavior, and that no artificial conflict between them and clinical judgment should be promoted. However, there must be a hierarchy. If clinical judgment prevails over results of scientific research, the science of clinical medicine will suffer.Cocconi is concerned about the "universality" of our clinical conclusions. He fails to understand that the key reason prompting the trial was the need to put to scientific scrutiny the widespread belief that routine use of instrumental and laboratory tests (in otherwise asymptomatic patients) improves patients' outcomes. Unless one challenges the validity of our conclusions, it is unfair to
Fossati R, Liberati A. Follow-up of Patients With Breast Cancer-Reply. JAMA. 1994;272(21):1658-1659. doi:10.1001/jama.1994.03520210041025