Medicine is a religion

8 Jan

And here are its tables of law

Ten Commandments

Thou Shalt Not (musical)

Image via Wikipedia

  • 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.


Time for a little of that religion.

The list was published on Richard Lehman’s blog but it was written by John Yudkin.

We fully acknowledge and thank Gary Schwitzer’s health news watch dog , the Carlat Psychiatry Blog and the BMJ blogger Richard Lehman who led us to these sound and wise tables of law full of awareness.
These ten commandments stem from the wisdom of practitioners all along the years. My preferred one is the tenth: “Honour the elderly patient, for although this is where the greatest levels of risk reside, so do the greatest hazards of many treatments.”
Because of my Confucians way of thinking?
And you, which is your preferred one?

If you want to read more:

5 Responses to “Medicine is a religion”

  1. docteurdu16 January 8, 2012 at 12:35 pm #

    You cannot ignore that Richard Lehman’post was primarily dedicated to surrogates. As I published here : Mais, comme on dit en français : Great minds think alike et, en anglais, les grands esprits se rencontrent.
    Best regards.

    • ha-vinh January 8, 2012 at 7:24 pm #

      Hello JCG, sorry not having quoted your post, but although I read it regularly, I swear I had passed your January 5th post dedicated to the surrogates. If I hadn’t I would have linked to your blog of course. It’s unforgivable. I subscribe absolutely to what you say; surrogates are far from sound clinical proof of benefit ‘or harm). Professor John Yudkin defines them as ” “biomarker[s] intended to substitute for a clinical endpoint [and] expected to predict clinical benefit (or harm . . .)…” by the way quoting himself the US institute of medicine.
      But, as we say in French they are a “pis aller”.
      Anyway many thank for having taken the time to comment my post.

  2. four blue hills photo blog January 8, 2012 at 3:21 pm #


    You have received the Candle Lighter Award. To view the award please visit: to learn more about it.

    • ha-vinh January 8, 2012 at 7:04 pm #

      Thank you a lot I really appreciate!! I’m confused! How this world goes is a responsibility each one of us is in charge. We shall stand up and speak the truth that we deeply feel, in our mind and conscientiousness. So things can’t do nothing else than get better. The world will not go to another direction than the good direction as long as every body will be authorized to speak and to light his own little candle!

      • four blue hills photo blog January 12, 2012 at 8:55 pm #

        You are welcome! I am sorry it took me a while to reply . New puppy, work, all kinds of stuff. You are so right in your assessment of each person’s responsibility, I agree with what you have said. 😉

        I like your blog, and I am very glad I came across it! 🙂

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