Toward the Perfect

At a meeting several years ago, Jim Armitage from Nebraska brought up an aphoristic dilemma: in the military world, “don't let the perfect become the enemy of the good” is an appropriate strategic approach. In the art world, however, “don't let the good become the enemy of the perfect” is more applicable. The question for clinicians, then, is whether we should operate in military or art world mode?In a sense, clinical practice guidelines represent “the good.” Because medical knowledge is imperfect in almost all areas, we recommend treatments that, even with the most innovative approaches tested in meticulously designed, high-powered trials, will not yield 100% success. In many areas, “the perfect” is not even on a realistic horizon. Instead, guidelines committees such as the NCCN Pancreatic Cancer Panel must assess how the finding that adding erlotinib to gemcitabine increases 1-year survival from 17% to 24% should be reflected in the treatment algorithm.The 3 articles on Hodgkin disease/lymphoma (HD) in this issue bring the dilemma to the fore. Given the extraordinary success rates of 94% to 98% overall survival in early stage disease, documented in the article by Yahalom, and encouraging new salvage regimens that result in 80% to 90% 5-year survival rates in advanced disease, as detailed by Advani et al., we can say that the good is approaching the perfect. But we still have steps to climb.With high success rates come increasing options. For HD, those options in-clude the chance to deal with a major roadblock...

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Rodger J. Winn is the Editor-in-Chief of JNCCN. He is Clinical Consultant at the National Quality Forum, and his past positions include Associate Professor of Clinical Medicine at The University of Texas M. D. Anderson Cancer Center. Dr. Winn received his medical degree from Jefferson Medical College of Philadelphia. His postgraduate training includes an internship and residency at Jefferson Medical College, and he also completed a medical oncology fellowship at Memorial Sloan-Kettering Cancer Center in New York. He is board certified in internal medicine and holds subspecialty certification in oncology.

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