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Analysis

The idolatry of the surrogate

BMJ 2011; 343 doi: https://doi.org/10.1136/bmj.d7995 (Published 28 December 2011) Cite this as: BMJ 2011;343:d7995

Rapid Response:

Re: The idolatry of the surrogate

I have learned across the years to be very careful about all dogmas in medicine, namely when they relate to complex diseases like hypertension and type 2 diabetes. Life (and complex systems theory) has taught me that there are no magic single (deterministic) therapeutic targets or "cure" for them.

The dogma of metabolic control in type 2 diabetes mellitus through the achievement of near normal glycaemic or HBA1C levels is one good example of this. The systemic derangements in type 2 diabetes seem to be much more complex than just glucose or HBA1C levels.

And it is very easy to start a dogma based on easy to achieve surrogates markers of disease processes.

These dogmas make-me remember of what said Dr. William Osler:

"The higher the ignorance, the higher the dogmatism"

Competing interests: No competing interests

02 January 2012
Jose Mario F. de Oliveira
Associate Professor of Medicine
Department of Medicine - Universidade Federal Fluminense
Rua Senador Vergueiro # 2 apt. 202, Rio de Janeiro, RJ, Brazil, ZIP CODE: 22230-001