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Letters Nalmefene in alcohol misuse

Bad medicine: using surrogate markers

BMJ 2014; 348 doi: (Published 10 March 2014) Cite this as: BMJ 2014;348:g2012
  1. S J McNulty, consultant physician1,
  2. P Williams, consultant physician1
  1. 1Whiston Hospital, St Helens and Knowsley NHS Trust, Prescot L35 5DR, UK
  1. sid{at}

Spence reports that nalmefene has been approved by the Scottish Medicines Consortium (and is being considered by the National Institute for Health and Care Excellence) for alcohol misuse on the basis of criteria such as a reduction in “high drinking levels” and increases in “non-drinking days,” with minimal improvements in liver function tests.1 Although we agree that improvements in liver …

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