The Story in Brief A Fateful Branching

What do these cases illustrate They indicate the intense hope and fear that drove women with a diagnosis of breast cancer to seek an experimental treatment presumed to offer better prospects than conventional therapy. They suggest the dependence of women on the advice they receive from their physicians, especially when a treatment is characterized as the only chance for a cure. The cases show how the demands of these women were expressed forcefully to and through families, physicians, clergy,...

Arbitrary and Capricious Standard in FEHBA and Champus Cases

The FEHBA authorizes the OPM to contract with private insurance companies to provide health benefits to all federal employees.83 The OPM has final authority to decide benefits and exclusions in all FEHBA plans. CHAMPUS is a health benefits program established by Congress to provide coverage to retired military personnel and their dependents.84 CHAMPUS, which is financed through funds appropriated by Congress, contracts with MCOs to provide coverage for its beneficiaries.85 In reviewing coverage...

The Media

The media (newspapers, magazines, and television) were also a major force in the use of HDC ABMT for breast cancer. They reported the story as women being denied access to lifesaving treatment by insurance companies interested only in financial considerations. Langer (2004) recalled how that organization had attempted to influence the general reporting of breast cancer in the late 1980s and early 1990s. The overlay to all of this is that huge tensions were created by the advent and growth of...

The Transplanters

Surgeons dominated the treatment of cancer until recent decades. Radiologists came to play a supporting role after World War II. Hematologists developed a similar role for leukemias and lymphomas. Only in the 1970s did medical oncology emerge as the primary cancer-treating specialty. Each group had its own treatment technology (surgery, radiotherapy, and chemotherapy) that depended partly on the prevailing concept of cancer and partly on the empirical outcomes of treatment. As oncology...

Randomized Clinical Trials Are Authorized

Payment for clinical research was a discussion in the abstract until HDC ABMT came into focus, Sue Gleeson of the BCBSA recalled (Gleeson 2002). A series of meetings in 1988-1990 forged a response to the specific issues raised by the new procedure. The medical directors of the Blue Cross Blue Shield plans met in fall 1988. Guests included Robert Wittes and Mary McCabe from the NCI and Karen Antman of Dana-Farber, who spoke about breast cancer and ABMT (Aronson 2002). Antman's message was that...

Acknowledgments

We owe an immense debt of gratitude to many individuals and regret our inability to thank them more than we do here. We thank I. Craig Henderson for help in understanding the clinical issues and for placing them in a larger context of both oncology and policy. We thank the many other clinical researchers we acknowledge as interviewees or whose papers we cite. We thank William P. Peters for a gracious interview toward the end of our research. We thank the many women, some of whom we cite in the...

Health Insurance and Medicine in the 1980s

Health insurers have been challenged repeatedly in recent decades to respond to new medical treatments, technologies, and innovations. Slowly and haltingly they have developed institutions and strategies that ask for evidence of medical effectiveness as an input to coverage decisions. These developments have often brought them into conflict with medical innovators, as they did in the HDC ABMT case. Health insurance developed in the pre- and post-World War II period well before medical research...