Thoughts: Hazards of dependence on surrogate endpoints
HK: Professor Yudkin et al. (The idolatry of the surrogate (2011)) offer a very important insight into the use of surrogate endpoints in medical science. They argue that this practice - so widespread, especially in diabetes care - is tantamount to losing sight of the patient's interest. It's a very readable piece -- a challenge to much of our work in public health & chronic-disease epidemiology. It adds to the growing chorus of criticisms directed at the "guidelines" we (used to) cherish.
HK: Professor Yudkin et al. (The idolatry of the surrogate (2011)) offer a very important insight into the use of surrogate endpoints in medical science. They argue that this practice - so widespread, especially in diabetes care - is tantamount to losing sight of the patient's interest. It's a very readable piece -- a challenge to much of our work in public health & chronic-disease epidemiology. It adds to the growing chorus of criticisms directed at the "guidelines" we (used to) cherish.
YC: I like to read this kind of article.We are fool only when we think surrogate is a real/only cause of the disease. I agree that the hard event is the most important for evaluation of a treatment. However, the authors seem ignoring the whole spectrum of development of science, which is from short range (quick surrogate) to long range (hard event). If a drug even cannot control the level of meaningful surrogate such as glucose and blood pressure, I don’t think that the drug is good for controlling of the hard event beyond the surrogate.
BTW, the example of rosiglitazone exactly demonstrates that the scientists or physicians (maybe I need say good scientists ^_^) didn’t forget the target beyond the glucose and stop digging up more evidences. Anyhow, this is a heads-up for someone.
BTW, the example of rosiglitazone exactly demonstrates that the scientists or physicians (maybe I need say good scientists ^_^) didn’t forget the target beyond the glucose and stop digging up more evidences. Anyhow, this is a heads-up for someone.
Selected References of The idolatry of the surrogate (2011):
- ebook: Institute of Medicin (2010).Evaluation of Biomarkers and Surrogate Endpoints in Chronic Disease.
- Yudkin JS, Richter B, Gale EAM. Intensified glucose lowering in type 2 diabetes: time for a reappraisal (2010); Intensified glucose control in type 2 diabetes—whose agenda? Lancet (2011)
- Emerging Risk Factors Collaboration (2010). C-reactive protein concentration and risk of coronary heart disease, stroke, and mortality.
- O’Connor PJ, Bodkin NL, Fradkin J, Glasgow RE, Greenfield S, Gregg E, et al (2011). Diabetes performance measures: current status and future directions.
- Lehman R, Yudkin JS and Krumholz HM (2010). Licensing drugs for diabetes.
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