Outcomes that matter to patients

There’s no shortage of examples of clinicians and patients being misled by surrogate outcomes. In some cases the results have been catastrophic. Last year Ray Moynihan reminded us that back in the 1980s flecainide, prized for its effect on reducing arrhythmias, killed tens of thousands of patients ( BMJ 2011;342:d5160). Citing the 2010 report from the US Institute of Medicine, which urged much greater caution in how we use surrogates, Moynihan called for a shift “from numbers to people” so that patients and doctors stop mistaking “a numerical benefit for a genuine one.” Now John Yudkin, Kasia Lipska, and Victor Montori join the …