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Letters Too much medicine

Beware the influence of the “SIF” (single issue fanatic) in clinical guidelines

BMJ 2013; 347 doi: (Published 30 July 2013) Cite this as: BMJ 2013;347:f4719
  1. Kevin Barraclough, general practitioner1
  1. 1Painswick, UK
  1. k.barraclough{at}

The start of science was arguably Descartes’ formulation of systematic doubt. Yet today the sceptic seems under-represented on expert committees.

Current guidance requires referral of every patient with a raised prostate specific antigen concentration (10% of men over 50), pigmented lesions that score 3 on the 7 point score (50% of pigmented lesions1), microscopic haematuria in the over 50s (up to 16.1% of …

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