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Is the quality of cancer treatment better in clinical trials?
Didier Verhoeven, MD, PhD

“Patients are better off when treated within the context of a clinical trial” is a generally accepted opinion in the oncological community.The American Society of Clinical Oncology (ASCO) and the US National Comprehensive Cancer Network (NCCN) have also taken the position that “the best management for any patient with cancer is in a clinical trial.1 “See guidelines/breast/index.html#/40/. Is this really the truth or is it a political statement to increase accrual and third party payment? Our analysis support the vision that patients are treated well in clinical trials but that there is insufficient data to claim a “beneficial” trial effect. A new treatment may improve outcome but may also lead to increased toxicity and/or cost. Patients may feel they are regarded as research object and less attention may be given to supportive and palliative care. Patients must be enrolled in a clinical trial on the basis of improving treatment options for future patients.

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Following the fire in the Mont Blanc tunnel, a new regulation was passed requiring each tunnel of a study of its specific risks and, for the transit of dangerous goods, a comparison with the risks alternative routes. In the practical implementation of these new studies, the temptation was great to multiply and more sophisticated modeling of fires, scenario analysis, the probability calculations, the criteria for making rational choices ... Group working to develop good practices, which had both an extensive field experience and scientific instruments, has gradually converged to a specific doctrine of "reasonable use" of science by their place in the traditional arguments based on simple rules, but tough. Be described by the complex trade-offs made ​​between two logics, the logic "hyperrationnelle" and the pragmatic logic, which are always more or less tension in the regulation of risk.

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