Comparative Effectiveness Research Not Aligned with Financial Incentives

Only after one of the trials examined, the Philadelphia Bone Marrow Transplant Group, did practice change.  In that study, researchers discovered that bone marrow transplantation added to both conventional and high dose chemotherapy for women with metastatic breast cancer sixth study did not improve survival than chemotherapy. 

In fact, there were higher risks of serious side effects from bone marrow transplantation.

"Treatment harms are a potent driver of changes in clinical practice," Timbie says.  "That's sort of a common thread, when harms are on the table, usually that is one of the main drivers in changes of practice."

The RAND team suggests that comparative effectiveness researchers should design studies with an eye to successful translation of whatever the findings are.

And they criticized bias that often is found in specialty society guideline development committees, which lack multi-specialty viewpoints and balance. Such committees should have "robust" conflict of interest policies, more complete documentation of the strength of evidence supporting each guideline, and the use of more explicit statements regarding the recommended clinical actions to take," which few now do.