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Invited Commentary
January 2014

Sometimes Consensus and Expert Opinion Is the Best We Can Do

Author Affiliations
  • 1Department of Surgery, University of Colorado, Aurora

Copyright 2014 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.

JAMA Surg. 2014;149(1):25. doi:10.1001/jamasurg.2013.3987

Brar et al,1 assembling a multidisciplinary expert panel of 16 physicians from 6 countries, follow the RAND/UCLA Appropriateness Method to try to define optimal treatment strategies for gastric adenocarcinoma. The strengths of this process are that it distinguishes between suggested and required care and defines which treatment options may be inappropriate. This study is helpful because it provides a summary of the agreement and disagreement of certain therapeutic options. We must remember that these guidelines are built by current thoughts and procedures and thus are heavily biased. To illustrate this point, had we assembled an expert panel on the use of lumpectomy for breast cancer several decades ago, the results would probably not reflect our current approach, which has been established by multiple high-level randomized clinical trials, some with counterintuitive results.2 Nonetheless, the group does represent a strong body of knowledge and expertise on the subject of gastric cancer and provides a nice summary of the current body of knowledge.

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