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According to Roman mythology, a handsome but vain young man, Narcissus, became thirsty while hunting in the woods. Kneeling down upon the banks of a stream, he became fascinated by his own reflection. Refusing to drink the water lest he damage the lovely image in the stream, and not realizing that he was in fact staring only at a reflection of himself, he eventually died of thirst. The tragic error of Narcissus was looking in the wrong place to meet his needs. 1 Events of the past 2 years have, in sometimes disconcerting ways, demonstrated that “evidence-based” medicine has been looking in the wrong places to meet many of the most important needs of the patients it serves. The results of 4 recent large clinical trials have highlighted the limitations of conventional wisdom regarding the value of key biomarkers in predicting clinical end points, and preliminary evaluation of the Medicare Health Support (MHS) demonstration project, a randomized trial of disease management interventions that had been touted by proponents as a way to “prove that disease management can be cost-effective at a

journal of managed care pharmacy

Looking for the Outcomes We Love in All the Wrong Places: The Questionable Value of Biomarkers and Investments in Chronic Care Disease Management Interventions