Although many pharmaceutical and technological advances are heavily touted, they have had relatively little impact on overall outcome improvements in the critically ill. Acting on the increasing recognition that 'less may be best' has, in my opinion, been the greatest single advance in patient management in the intensive care unit in the past 10 years. Although certainly not qualifying as a 'brave new world' in terms of daring and exciting innovation, the importance of (often covert) iatrogenic complications should not be underestimated.