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April 21, 2004

Off-Pump Bypass Surgery—Ready for the Big Dance?

Author Affiliations

Author Affiliations: Outcomes Research and Assessment Group, Duke Clinical Research Institute and the Department of Medicine, Duke University Medical Center, Durham, NC.

JAMA. 2004;291(15):1897-1899. doi:10.1001/jama.291.15.1897

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."

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