Amid the steady drumbeat of warnings about escalating medical costs, clear-cut guidelines for conservative treatment are appealing, writes Megan McArdle, but they are also largely unrealistic and ignore crucial aspects of good clinical care. McArdle's piece follows a New Yorker article by cardiologist Dr. Lisa Rosenbaum that noted guidelines that advance strict treat/don't treat directives are often based around "rarefied environments" in clinical trials that bear little resemblance to real-life treatment scenarios, where challenges such as patient preference and adherence pose real obstacles to helping patients get well.

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