This press release talks about "partnerships" between major academic cancer centers and community hospitals hightening the oncologist's ability to provide the care they judge most appropriate for their cancer patients.

Sometimes oncologists like to think for themselves. Perhaps they know of cutting-edge technology that has run through the riggers of evidence, but not attached to "standards." The self-educated oncologist doesn't like to submit to the status-quo of treatments which are only marginally, minimally and inconsistently effective. They can think for themselves.

Sometimes oncologists may question an occasional guideline message on the basis of profit conflicts. Specialty medical societies work to insure their specialist members get reimbursement for common procedures and treatments, and the drug industry works to produce evidence statements that promote use of their brands.

Perhaps some oncologists are not comfortble that many clinical trials are unobjective and balanced. The use of clinical trials to establish prescribing guidelines for evidence-based medicine is highly criticized because such trials have little relevance for the individual patient in the real world, the individuality and uniqueness of each patient.

Guidelines seem fine, but many oncologists use other guidelines or develop evidence-based treatment guidelines for their own individual practices or modify guidelines based on evidence which they use as their defined evidence-based standards for their practices.

While on the surface guideline policy sounds logical, but to utilize all therapies on individuals based on the average of population studies has been very harmful to progress.

Then there is an inherent conflict of interest when organizations that provide guidelines for treating a disease also receive funding from corporations that benefit financially from the recommended treatment. There is no proof beyond reasonable doubt for any approach to treating advanced cancer today.

In life or death situations, one must make judgements based upon preponderance of available evidence as opposed to proof beyond reasonable doubt. Many time, thinking "outside the box" can help to improve things.