The controversy over high-dose chemotherapy with autologous bone marrow transplant for breast cancer

In the 1990s more than 41,000 patients underwent high-dose chemotherapy plu s autologous bone marrow transplant (HDC-ABMT) for breast cancer, despite a paucity of clinical evidence of its efficacy. Most health plans reluctantl y agreed to cover the treatment in response to intensive political lobbying and the threat of litigation. The results of five recent major randomized trials showed that HDC-ABMT offers no advantage over standard-dose treatmen t for breast cancer. Our experience with HDC-ABMT coverage cautions against allowing politics to overwhelm science in the area of evaluating experimen tal procedures, and against relying on the courts as a means of resolving d isagreements about coverage of these interventions.