False Hope Bone Marrow Transplantation for Breast Cancer

by Rettig, Richard A.; Jacobson, Peter D.; Farquhar, Cynthia M.; Aubry, Wade M.

• ISBN13: 9780195187762
• ISBN10: 0195187768
• Edition: 1st
• Format: Hardcover
• Copyright: 2007-01-25
• Publisher: Oxford University Press

Summary

In the late 1980s, a promising new treatment for breast cancer emerged: high-dose chemotherapy with autologous bone marrow transplantation or HDC/ABMT. By the 1990s, it had burst upon the oncology scene and disseminated rapidly before having been carefully evaluated. By the time published studies showed that the procedure was ineffective, more than 30,000 women had received the treatment, shortening their lives and adding to their suffering. This book tells of the rise and demise of HDC/ABMT for metastatic and early stage breast cancer, and fully explores the story's implications, which go well beyond the immediate procedure, and beyond breast cancer, to how we in the United States evaluate other medical procedures, especially life-saving ones. It details how the factors that drove clinical use--patient demand, physician enthusiasm, media reporting, litigation, economic exploitation, and legislative and administrative mandates--converged to propel the procedure forward despite a lack of proven clinical effectiveness. It also analyzes the limited effect of the technology assessments and randomized clinical trials that evaluated the procedure and the ramifications of this flawed system on healthcare today. Sections of the book consider the initial conditions surrounding the emergence of the new breast cancer treatment, the drivers of clinical use, and the struggle for evidence-based medicine. A concluding section considers the significance of the story for our healthcare system.

Table of Contents

Introduction	p. 3
Initial Conditions
Breast Cancer Patients and the Emergence of a Treatment	p. 11
Jumping the Gun	p. 35
Drivers of Clinical Use
Court Trials	p. 73
Litigation Strategies	p. 103
Entrepreneurial Oncology	p. 129
Government Mandates	p. 152
The Struggle for Evidence-Based Medicine
Technology Assessments	p. 181
Clinical Trials	p. 206
Denouement	p. 239
The Significance of the Story
Values in Conflict	p. 259
Evidence-Based Reviews of Clinical Trials	p. 287
Notes	p. 301
References	p. 315
Index	p. 343
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