Rushed decisions in medicine can lead to severe consequences. The 20th century offers numerous cautionary tales, from the thalidomide tragedy—a morning sickness medication inadequately tested on expectant animals—to the widespread adoption of low-fat diets, inadequately supported by robust evidence. Yet, equally hazardous is the reluctance to embrace progress too slowly. The body mass index (BMI) serves as a pertinent illustration of this challenge.
For decades, it has been understood that this measurement, a straightforward calculation of weight against height, functions as an overly simplistic metric. It fails to differentiate between fat and muscle mass and does not adequately reflect the diversity of global populations. While its advantages lie in its speed, low cost, and simplicity, its prolonged application has led to millions being misidentified as overweight. Such misdiagnoses carry significant repercussions, including exclusion from fertility treatments and denial of access to specific surgical procedures.
Fortunately, superior alternatives exist and are gradually being implemented. In the past year, The Lancet played a role in accelerating this long-overdue shift by advocating against the sole use of BMI for obesity assessment. This recommendation was subsequently adopted by seventy-five international medical organizations.
This development signals a potential shift away from broader medical stagnation. Such inertia stems not only from the necessary safety protocols established after the errors of the previous century but also from a deficit in strong evidence, a lack of clear consensus, and the absence of decisive leadership required to enact change.
The rapid development of COVID-19 vaccines provides a compelling example of what is achievable. These vaccines, produced in an unprecedented timeframe, are estimated to have saved 14 million lives within their first year of use, demonstrating that swift, safe, and evidence-based action is indeed possible.
This proactive approach is crucial for numerous healthcare areas currently experiencing stagnation. Improved menopause care, novel psychiatric treatments, expanded male contraception options, and innovative antibiotics are just a few examples of fields where progress is urgently needed.
While caution is warranted, the current juncture demands swift yet careful advancement.