caa a22 4500 386356645 CHVBK 20180307111855.0 cr unu---uuuuu 161130e198907 xx s 000 0 eng 10.1017/S0266462300007443 doi S0266462300007443 pii (NATIONALLICENCE)cambridge-10.1017/S0266462300007443 Baum Michael King's College School of Medicine and Dentistry, Rayne Institute Limitations of Nonscience in Surgical Epistemology: The Second-Look Laparotomy [Elektronische Daten] [Michael Baum] 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. Copyright © Cambridge University Press 1989 International Journal of Technology Assessment in Health Care Cambridge University Press 5/3(1989-07), 381-388 0266-4623 5:3<381 1989 5 THC https://doi.org/10.1017/S0266462300007443 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1017/S0266462300007443 text/html Onlinezugriff via DOI NATIONALLICENCE 100 1- Baum Michael King's College School of Medicine and Dentistry, Rayne Institute NATIONALLICENCE 773 0- International Journal of Technology Assessment in Health Care Cambridge University Press 5/3(1989-07), 381-388 0266-4623 5:3<381 1989 5 THC CC0 http://creativecommons.org/publicdomain/zero/1.0 nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-cambridge