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2 Comments

  1. 1

    Jenny Haines

    That’s easy to answer – surrogate markers are considered more important because they allow non clinical managers to sit in their offices engaging in so called monitoring of clinical care using the markers while actual clinical care goes down the toilet because of the lack of experienced and skilled staff.

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  2. 2

    Jimmy

    Strange article. I understand (though don’t agree with) the premise, however the background reasoning is faulty to say the least.

    Diabetes is a silent disease – ie the irreversable damage is done over a typically long period of time with typically minimal symptoms, and those that are suffered early are easy to ignore. Good blood sugar level management = delayed onset of debilitating eye, sensory, cardiac, and kidney symptoms. Good sugar management level requires regular testing to ensure sugar levels are neither too high OR too low. Waiting until the patient has ‘end points’ which are ‘central to the patient experience’ such as amputation, renal, or retinal problems kind of misses the point doesn’t it? Perhaps we should recommend patients taste their own urine for presence of sugar to give them someting ‘central to the patient experience’!

    Jenny – to equate use of surrogate markers with ‘non-clinical managers’ is disingenous. In this example, surrogate markers are of critical importance to pick up and manage diseases with long term sequele but minimal to no observable symptoms. Perhaps a more appropriate argument is that too much money is wasted on health care which would be better spent on subsidies for lifestyle interventions – exercise / improved diet / harm minimisation.

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