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Intermediate outcomes and inadequate controls made preliminary evidence
of the benefits of bone marrow transplantation for breast cancer
misleading. Statements by doctors in the medical literature and the
general press in the United States reinforced the presumption of
benefit, as did the decision of government bodies to mandate insurance
coverage. The findings of major randomised trials did not support the
use of the treatment. Welch and Mogielnicki (p 1088) describe the
American experience, where for more than 10 years the major dilemma was
who should pay for bone marrow transplantation, not whether it
worked or not. They say it provides lessons relevant to complex cancer
treatments currently in development.