I respect Dr Paradise and associates in their commitment to conduct scientific studies in an effort to resolve this issue. While the question of whether this should be done in one institution or in many centers may be important to those researchers actively involved in the issue, only the conclusions and their validity are of concern to the practicing physician.
Unfortunately, these authors failed to appreciate the major thrust of my COMMENTARY, which was the difficulty—virtual impossibility—of designing a study that will win universal acceptance of its conclusions. If Dr Paradise and colleagues had been present for the major deliberations of the "consensus conference," they would have appreciated how much diversity of opinion existed among the blue-ribbon panel convened to arrive at a consensus on the issue.
The panel had before it a number of positive recommendations for a nationwide study of the issue, recommendations that Paradise et