Intended for healthcare professionals

Rapid response to:


The idolatry of the surrogate

BMJ 2011; 343 doi: (Published 28 December 2011) Cite this as: BMJ 2011;343:d7995

Rapid Response:

Re: The idolatry of the surrogate

The authors must be congratulated on bringing realism to the interpretation of the potential benefits of apparently successful therapeutic interventions. It should be recognised that as we progress down the continuum from a patient suffering from an otherwise inevitably fatal disease to a healthy individual, specific outcome measures and in particular cause of death and ultimately death itself all become surrogates for the only proper public health measure of success healthy survival, This was well illustrated recently when a researcher, who presented a association between death rates and diet as proof of benefit, was asked by a journalist on the BBC programme Today “What was the effect on survival?” The researcher responded that he could not say as it was a cross-sectional study. Clearly the study should not have been publicised until the apparent benefit as indicated by the surrogate of death rates in a cross-sectional study had been confirmed as enhanced survival in a longitudinal one.

The article should be a timely reminder for those who understandably wish to eradicate ‘their’ disease should recognise that their specific success is only a surrogate for the ultimate goal of lengthening the healthy for all, and that sometimes the surrogate might flatter.

Competing interests: No competing interests

14 January 2012
Dr CK Connolly
Retired Physician
Aldbrough St John, Richmond, DL11 7UJ