http://www.guideline.gov/summary/summary.aspx?doc_id=5298&nbr=3621'

Ha ha – I don't believe you picked this at random as the decision to administer adjuvant CT for stage II colon cancer is not black and white. But as you raise it, the guideline is based on current evidence – there are a few other major trials but nothing is showing more than a very small advantage for adjuvant CT, but like much cancer therapy we lack the biomarkers to tell us who will actually benefit. There are some known high risk groups but I don't think we have any overall survival data.

The guideline is quite clear about discussing all the available evidence with patients and it is just a guideline. And it also states we need to move forward by enrolling patients in clinical trials.

This rather does put paid to your objections. Guidelines are also very useful for patients as well and this particular one is actually the opposite of 'driving up costs by forcing lots of procedures and lots of time' as for the vast majority doing nothing is best after surgery.

http://www.guideline.gov/summary/summary.aspx?doc_id=5298&nbr=3621

Mostly academics, their conflicts of interest are listed at the bottom, and some …, some are even Canadian. They never work hard.

The idea that these geniuses will boss clinicians is out of the question. For them, medicine is to show their great scholarship. For them, patients are a dirty nuisance interrupting their great mentations.

One notes the date, 2004, reflecting the medicine not of 5 years ago, as I claimed, but of 10 years ago.

The guideline is copyrighted and there is some chance I could be sued for linking to it.

It recommends no adjuvant therapy be given for follow up. That means, this is a type of lawmaking. If a doctor chooses to give adjuvant therapy in individualized treatment, and a side effect hurts the patient, the tort is automatic, per se. No proof of negligence need be shown. It is the doctor that must educate the jury as to why his treatment was superior to this endorsed standard of care. That is why, the professional society and these doctor oppressor should be deterred with cross claims in any medmal case.

Additionally, lets see Trial Bar and AMA vet this puppy. Not in a million years.

This is utter nonsense. For anyone reading these comments who thinks from the above that, for example, oncology guidelines are not written by top front-line practitioners – don’t believe it. Remember, these extreme right-wing nuts would have you believe there’s no global warming, no crisis in capitalism and the moon’s made of green cheese.

The studies are not only obsolete, they use parametric statistics based on the bell shaped curve. That reflects the fractions in the bigger population. Clinical care is a series of single case, on-off, on-off experiments, which have a binomial distribution, like coin tosses, covered in 11th grade statistics class. The application of parametric statistics to a series with a binomial distribution is not permitted.

The guidelines are written by people with a lot of time, academic, Ivy twits, subject to pressures of all kinds and to conflicts of interest, mostly rent seeking, i.e. driving up costs by forcing lots of procedures and lots of time.

In the stimulus bill, guidelines will be used to reduce cost. Not to enhance care, but to reduce cost. The FBI will coming around to enforce them against docs.

Most guidelines violate the guidelines on guideline making, as well. A call has gone out to revamp the latter.

What’s the algorithm for when a C-section is required to prevent brain injury to baby?

If you can write that down in less than one page, your idea might have some merit.

The second there is an implication of coercion, of bossiness, of telling people what to do, of limiting another’s actions, that is an act, and not speech. If I say, rob a bank this way, at this point, that is not speech, that is the act of command of a crime. And all malpractice defendants following a guideline should file a cross claim against the guideline maker, the employers and the professional society, even if they never used the guidelines. There is precedent for doing so in the pool building business.

Total legal accountability should be brought to these doctors, and no pity should be shown them nor their funding sources, nor their employers. The model is the command to rob a bank and the RICO statute, not the First Amendment immunized textbook.