Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
To the Editor: Dr Berwick1 implied
that physicians' delay in adopting innovations leads to suboptimal health
care. There are some instances, however, where precisely the reverse is true.
Physicians often rush to adopt a new modality of treatment based on preliminary
or even anecdotal data, only to find that benefits have been greatly exaggerated.
One example is adjuvant high-dose chemotherapy and bone marrow transplantation
as the treatment of choice for high-risk breast cancer. Thousands of women,
at a cost of tens of millions of dollars2 and
perhaps dozens of lives, received this treatment before controlled clinical
trials were finally performed to see if this treatment was actually beneficial.
None of the trials demonstrated a statistically significant advantage in overall
Yaes RJ. Disseminating Health Care InnovationDisseminating Health Care Innovation. JAMA. 2003;290(11):1454-1455. doi:10.1001/jama.290.11.1454-a