- Thou shalt treat according to level of risk rather than level of risk factor.
- Thou shalt exercise caution when adding drugs to existing polypharmacy.
- Thou shalt consider benefits of drugs as proven only by hard endpoint studies.
- Thou shalt not bow down to surrogate endpoints, for these are but graven images.
- Thou shalt not worship Treatment Targets, for these are but the creations of Committees.
- Thou shalt apply a pinch of salt to Relative Risk Reductions, regardless of P values, for the population of their provenance may bear little relationship to thy daily clientele.
- Thou shalt honour the Numbers Needed to Treat, for therein rest the clues to patient-relevant information and to treatment costs.
- Thou shalt not see detailmen, nor covet an Educational Symposium in a luxury setting.
- Thou shalt share decisions on treatment options with the patient in the light of estimates of the individual’s likely risks and benefits.
- Honour the elderly patient, for although this is where the greatest levels of risk reside, so do the greatest hazards of many treatments.
Sociodemographic And Lifestyle Statistics Of Oldest Old People (>80 Years) Living In Ikaria Island: The Ikaria Study, Cardiology Research and Practice, February 2011
"The majority of the oldest old participants reported daily physical activities, healthy eating habits, avoidance of smoking, frequent socializing, mid-day naps and extremely low rates of depression.Modifying risk factors through lifestyle changes can be as effective, if not more effective, than drug therapy. It may not be as lucrative.
Conclusion: Modifiable risk factors, such as physical activity, diet, smoking cessation and mid-day naps, might depict the “secrets” of the long-livers."
There is so much in this list that I like, not least of which the warning against medicating to a surrogate endpoint instead of a hard endpoint. That is, the warning against medicating to, say, reduce cholesterol or blood glucose (surrogate endpoints) instead of to reduce heart attacks or strokes or premature death (hard endpoints).
I really like that last commandment, although I wouldn't single out the elderly. I would apply it to all patients. Just "Honour thy patient."
The sketch is by Rembrandt, a self-portrait, from RembrandtPainting.