British perspective on the U.S. Preventive Services Task Force guidelines.

The clinical approach to prevention, cogently documented in the Task Force guidelines, implies the medicalization of prevention. The concentration of resources on those most in need is efficient, the widening of physicians' responsibility is welcome, and the influence on the recipients diffuses into the community. The Task Force report, however, fails to stress the problems and the limitations of this approach. The adverse effects of "labeling" can be serious. They need to be measured and taken into account, and there should be no screening without counseling and long-term care; the latter cannot be guaranteed unless there is a comprehensive general practitioner system. Screening readily generates overmedication, particularly since many physicians lack the skills, the inclination, or the staff to provide expert and continuing health advice. Concern for high-risk individuals should be only one part of a much wider preventive strategy. This is illustrated by the close correlations between the prevalence of high-risk status and the population mean value (0.85 for hypertension vs. mean blood pressure, 0.97 for excess use of alcohol vs. population mean intake). The medical approach, important though it is, must not distract attention from the more fundamental population strategy of prevention.