Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
To the Editor: Dr Clark and colleagues1 found an increased use of an experimental, unproved
therapy (apheresis) by community physicians during the time that randomized
controlled trials of that therapy were being performed. The authors called
this behavior "jumping the gun."
The authors' examples, however, suggest that physicians may have anticipated
the trials' results prior to publication. For example, Clark et al found that
use of apheresis for thrombotic thrombocytopenic purpura increased gradually
during the relevant trial.2 That increase
continued after the trial found a positive effect. In contrast, during a trial
of apheresis for multiple sclerosis3 (which
found the treatment to be ineffective after a slight trend favoring apheresis
during the first 2 years), the use of apheresis among nontrial patients increased
during the first 2 years of the trial but decreased in the last year of the
trial, before its lack of effectiveness was demonstrated. This decrease contrasts
with the increased use of apheresis among the multiple sclerosis trial participants
up to the end of the trial.
Boutron I, Ravaud P. Premature Application of Trial Results to Clinical Practice—Reply. JAMA. 2003;290(23):3072. doi:10.1001/jama.290.23.3072-a