Richard A. Rettig, Ph.D

Image: 

Richard A. Rettig, Ph.D., is an adjunct senior social scientist at the RAND Corporation's Washington office. Dr. Rettig was at RAND from 1975 until 1981, and returned in 1995. He served at the Institute of Medicine (1987-1995) as Director of the Council on Health Care Technology; Acting Director of the Drug Development forum; and directed studies of the Medicare End-Stage Renal Disease program, the Food and Drug Administration advisory committee system, and federal government regulation and methadone treatment.

Dr. Rettig was trained in Political Science at the Massachusetts Institute of Technology and taught at Cornell University, Ohio State University, and the Illinois Institute of Technology. He is the author of Cancer Crusade: The Story of the National Cancer Act of 1971 (Princeton, 1977, republished by Authors Choice Press, 2005) and has also written about end-stage renal disease, organ transplantation, health care technology assessment, clinical research, and medical innovation.

In December 2001, HCFO awarded Dr. Rettig a grant to explore the U.S. experience with high-dose chemotherapy and autologous bone marrow transplantation (HDC/ABMT) for breast cancer treatment. He and his colleagues, Peter Jacobson, J.D., M.P.H. (University of Michigan School of Public Health); Cynthia Farquhar, M.D. (University of Auckland New Zealand); and Wade Aubry, M.D. (Health Technology Center and the University of California at San Francisco Institute of Health Policy Studies), examined how treatment decisions were made and drew lessons for the use of other emerging technologies.

In a four-city, two continent collaboration, the researchers analyzed two parallel pathways of rapid (and premature) clinical use of HDC/ABMT and the much slower evaluation of the procedure by randomized clinical trials. Rapid clinical use was driven by patient demand, physician enthusiasm, courtroom trials, entrepreneurial oncology, and federal and state government mandates. They also examined how the absence of data of effectiveness, repeatedly indicated by many technology assessments, failed to slow diffusion. Only the existence of data showing no benefit, generated by randomized trials, decisively ended widespread use.

In this in-depth case study, Rettig and his colleagues found that three major factors drove HDC/ABMT along these parallel paths of widespread clinical use and slow accrual of patients to randomized controlled trials: initial conditions governed later developments; conflicting values presented themselves at every stage; and an institutional deficit, the absence of an authoritative body to oversee the evaluation of new medical procedures, hampered systematic evaluation. Their findings, discussed in detail in their forthcoming book False Hope: Bone Marrow Transplantation for Breast Cancer¹, demonstrate the complex dynamics surrounding the introduction of new treatments for life-threatening conditions prior to adequate, evidence-based evaluation.

For more information on Richard A. Rettig, PH.D., and a list of selected publications, see www.rand.org/pubs/authors/r/rettig_richard.html

______________________

1 False Hope: Bone Marrow Transplantation for Breast Cancer by Richard A. Rettig, et.al., is available at a pre-publication discounted rate of $42.50 (regularly $49.95) through Oxford University Press. For additional information or to order online, go to www.oup.com/us/ and use promo code 25102.