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Limits in medicine seem a contradiction in terms. Medicine advances continuously, shattering orthodoxies and opening new possibilities, some of which succeed spectacularly while others are mere incremental steps forward, overoptimistic dead ends, or (rarely) deceptive fabrications. The idea of a conference entitled "At the Limits" therefore seems entirely correct and a misnomer. Correct because debating knowledge on the edge of breakthrough is what medicine is about. Misnomer because, since medicine has no limit, one cannot be "at" something that does not exist. What one might say is that medicine is defined by a permanent transgression of boundaries around acceptable understanding. A systematic review recently argued that blood pressure should be reduced below the accepted limit of 140 mm Hg. The After Eighty Study found that aggressive intervention in older patients with non-ST-elevation myocardial infarction was more successful than conservative strategies. Medicine does live at the limits. Last week, Professors Derek Yellon and Lionel Opie convened their latest scientific symposium on Cardiology, Diabetes, and Nephrology At the Limits in London. It was a celebration of progress...