SIR

A conference of philosophy of medicine in Crakow, August 2000, offered the opportunity to visit Auschwitz—an offer reluctantly accepted by the author who had two decades ago, spent some months in Israel, cried at Dachau, treated (in the course of consultant practice over three decades in oncology and palliative medicine) many holocaust survivors, and counts among close friends and colleagues persons profoundly affected by Auschwitz and associated activities. Surely, the visit would be simply a mark of respect, and an episode of further personal grieving maybe, but not enlightenment. This was not the case.

The lasting impression has been that of the dangers of efficiency as a value in itself, the inadequacy of outcome measures if the array is incomplete, and the need for clear articulation not only of goals, but …