Reporting the clinical importance of randomized controlled trials.

T implement bedside rationing as described in Peter Ubel’s Pricing Life: Why It’s Time for Health Care Rationing would most certainly set medical ethics back 2500 years by ignoring the issue of patient trust, which gave rise to the traditional Hippocratic oath. The fundamental unit of health care is the physician–patient relationship. For physicians to knowingly withhold beneficial services from patients to promote the financial interests of others (or of themselves) would introduce suspicion into that relationship, further subjectivize the practice of medicine, and increase the power disparity between physician and patient. What patient wouldn’t question the physician’s commitment under such circumstances? Should rationing ultimately become necessary, then bureaucrats must impose it broadly, at the system level, for the sake of maintaining consistency across the population and of minimizing physician conflict of interest. Patients must also have the option of obtaining services privately. Before Hippocrates, the sick could never be certain of their physicians’ motives or competing interests, but generations since have enjoyed the peace of mind that comes from the physician’s pledge to do no harm. Bedside rationing would undermine this precious gift that has protected us all.