If less is more, how much is zero?

doi:10.1136/bmj.b3500

Published 1 September 2009, doi:10.1136/bmj.b3500
Cite this as: BMJ 2009;339:b3500

Letters

Unnecessary interventions

If less is more, how much is zero?

The first 150 words of the full text of this article appear below.

If we need less medicine,¹ how much less? Given the accumulatingevidence that revascularisation may not add anything to patients’changing their lifestyle, how much angioplasty or coronary arterybypass grafting should be performed? The peer reviewed evidenceoverwhelmingly suggests that in most stable cases the answeris none.

Why has primary health care failed? Why has Health for All by2000 been lost to oblivion? Why is prevention a far cry? Whyhas caring for the sick become all of health care? And, whyhas the practice of medicine been reduced to maintaining andnurturing preventable and reversible diseases among those whohave them, while allowing these diseases to afflict those whodon’t yet have them?

The answers may not be palatable for a sick care society thathas become so addicted to medical breakthroughs that 80% ofpreventable and reversible lifestyle diseases are treated withlifelong drug treatment. . . . [Full text of this article]

Fazal Raheman, consultant and chief executive officer¹

¹ Suite 217, Twin Towers, Box 4404, Dubai, United Arab Emirates

dr.fazal@mrilimited.com