Of silver bullets and red herrings: invited commentary to Fisk et al.

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A ‘red herring’ is something that diverts attention from a topic or line of inquiry (Collins 2009). We believe that the main line of argument in the Viewpoint by Fisk et al. (2011) constitutes such a red herring. By enthusiastically promoting investment in Research & Development (R&D) for new drugs and diagnostic techniques, the authors divert attention from the top priorities in maternal and perinatal health in lowand middle-income countries. These priorities are (as Fisk et al. state in their paper): providing access to comprehensive reproductive health services, to skilled care during and immediately after childbirth, and to emergency care when life-threatening complications develop (International Women’s Health Program 2009). Fisk et al. do not challenge that health services in lowand middle-income countries need to be improved. But they anticipate new pharmaceutical products and diagnostic techniques which they imply will make independent contributions towards improving maternal and perinatal health – provided that there will be increased investment in R&D. We are not told what exactly these products will be like. They are so far entirely hypothetical, but will supposedly offer effective technical solutions to longstanding social and health problems. One can see Fisk et al. Viewpoint as visionary – or as peddling ‘silver bullets’, magically simple solutions to longstanding, complex problems. With their message, Fisk et al. risk diverting not only attention but also scarce resources – in the worst case, away from the health care services in need of improvement.