Ten Commandments of “the new therapeutics”

Sometimes I blog things that I see just to ensure that I have a place to keep them.  This is one of those times. Because this is a keeper.

The Carlat Psychiatry Blog re-posted a list from BMJ blogger Richard Lehman – Ten Commandments for excellent clinical practice.

The New Therapeutics: Ten Commandments

  • 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.


Time for a little of that religion.

Comments (4)

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Marilyn Mann

January 6, 2012 at 8:05 pm

Clarification: the list was published on Richard Lehman’s blog but it was written by John Yudkin.

Gary Schwitzer

January 8, 2012 at 10:20 am


Thanks for your correction.

Please also note that Alice Dreger posted a laymen’s explanation of the “Ten Commandments” for those who may not be aware of some of the terminology.