If you missed Richard Lehman's blog in the BMJ this week, you missed
his quotation of John Yudkin's "Ten Commandments of the New
Therapeutics", which should be engraved in every prescriber's brain.
Thou shalt treat according to level of risk rather than level of risk factor
Thou shalt exercise caution when adding drugs to existing polypharmacy
Thou shalt consider benefits of drugs as proven only by hard endpoint studies
Thou shalt not bow down to surrogate endpoints, for these are but graven images
Thou shalt not worship Treatment Targets, for these are but the
creations of Committees
Thou shalt apply a pinch of salt to Relative Risk Reductions,
regardless of P values, for the population of their provenance may
bear little relationship to thy daily clientele
Thou shalt honour the Numbers Needed to Treat, for therein rest the
clues to patient-relevant information and to treatment costs.
Thou shalt not see detailmen, nor covet an Educational Symposium in a
luxury setting
Thou shalt share decisions on treatment options with the patient in
the light of estimates of the individual’s likely risks and benefits.
Honour the elderly patient, for although this is where the greatest
levels of risk reside, so do the greatest hazards of many treatments.
http://blogs.bmj.com/bmj/2012/01/03/richard-lehmans-journal-review-3-january-2012/
All we need now is ten commandments for diagnostic testing.
Michael
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