Author Affiliations: Outcomes Research and Assessment Group, Duke Clinical Research Institute and the Department of Medicine, Duke University Medical Center, Durham, NC.
Every spring, college basketball teams from around the United States
gear up for a competition to determine the best team of the year. This tournament
is often referred to as the "big dance," and it represents the ultimate challenge
of peer against peer. In this contest, dominance in prior years is no guarantee
of continued success. In medicine, new technologies are continuously being
developed to challenge the champions of prior years, but there is no calendar
marking when a new therapy is ready for its "big dance"—the large multicenter
randomized trial that can determine whether it should displace the reigning
champion of conventional care in clinical practice. If the assessment comes
too early as the therapy is still evolving, a promising treatment may be inappropriately
discarded. If the assessment comes too late, practitioners may have already
decided to adopt the therapy based on less rigorous evidence and may refuse
to enroll patients into a trial based on "ethical grounds."
Peterson ED, Mark DB. Off-Pump Bypass Surgery—Ready for the Big Dance?. JAMA. 2004;291(15):1897-1899. doi:10.1001/jama.291.15.1897