Ethical issues in the allocation and reimbursement of bone marrow transplantation.

At its best, today's conference might be an attempt to limit the premature dissemination of poorly studied, toxic, expensive therapies to desperate patients by accepting limitations to BMT, especially outside of a well-designed experimental study; and, at the same time, an acknowledgment that, in certain circumstances, the patient's best interests are served by receiving experimental therapy (never mind the interests of society) and that our current patchwork system of reimbursement is inherently unfair in its inconsistency. If we can agree on this, there is some small hope that we can reach a fair consensus regarding cases like Mrs. Washburn's. If experimental therapy is distinguished from standard therapy not only in terms of efficacy, but in terms of method and intent, it becomes apparent that experimental therapy is not a monolithic entity, and has a large and sometimes predictable range of probabilities of benefiting the individual patient. Consideration ought to be given to bypassing the experimental vs. standard debate altogether, working toward consensus regarding reimbursement decisions using alternative methods for assessing efficacy and allocating medical care.