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February 17, 1989

Adjuvant Chemotherapy in Colorectal Cancer: Mournful, Hopeful Perpetual Motion Machine Heads to Dim Light at End of Tunnel-Reply

JAMA. 1989;261(7):988. doi:10.1001/jama.1989.03420070037012

In Reply. —  We could not have dreamed of clearer confirmation for the title of our article than these two letters, one claiming that randomized clinical trials of adjuvant chemotherapy in colorectal cancer are no longer needed because the benefit associated with treatment has been established clearly and the other claiming that no meaningful benefit has ever been, nor will soon be, demonstrated. We take issue with both claims and plead for a less glamorous, but more honest, acknowledgment of uncertainty.As potential patients with this disease, we find it ethically worrying that Dr Clouse would deny us the potential benefit of adjuvant therapy while Dr Bruckner would impose on us an as yet unproved therapy. We agree with the authors of the editorial1 that the most rational attitude, and therefore that most consistent with ethics, is to perform further clinical trials in this disease. Such trials do not