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September 17, 2003

Disseminating Health Care InnovationDisseminating Health Care Innovation

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;290(11):1454-1455. doi:10.1001/jama.290.11.1454-a

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 survival.3,4