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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 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 analyses the failure of the technology assessments and randomised 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.
- Part I: Initial Conditions
- 1: Breast Cancer Patients and the Emergence of a Treatment
- 2: Jumping the Gun
- Part II: Drivers of Clinical Use
- 3: Court Trials
- 4: Litigation Strategies
- 5: Entrepreneurial Oncology
- 6: Government Mandates
- Part III: The Struggle of Evidence-Based Medicine
- 7: Technology Assessments
- 8: Clinical Trials
- 9: Dénoument
- Part IV: The Significance of the Story
- 10: Values in Conflict
