The publication of the Guide to Clinical Preventive Services marks the beginning of an important new phase in the battle against premature death and disability. Abundant evidence documents that the majority of deaths among Americans under age 65 are preventable, many through interventions best provided in a clinician's office. The means are available to prevent many of these premature deaths, as well as many injuries and other types of morbidity. This Guide, resulting from the most comprehensive evaluation and synthesis of preventive interventions to date, offers an operational blueprint for their delivery. Prepared under the supervision of the U.S. Preventive Services Task Force for presentation to the U.S. Department of Health and Human Services, the Guide rigorously reviews evidence for over 100 interventions to prevent 60 different illnesses and conditions. The problems addressed in this report are common ones seen every day by primary care providers: cardiovascular and infectious diseases, cancers, injuries (both intentional and unintentional), alcohol and other drug abuse, and many others. Primary care clinicians have a key role in screening for many of these problems and immunizing against others. Of equal importance, however, is the clinician's role in counseling patients to change unhealthful behaviors related to diet, smoking, exercise, injuries, and sexually transmitted diseases. The Guide is the culmination of over four years of literature review, debate, and synthesis of critical comments from expert reviewers. It offers the Task Force members' best judgment, based on the evidence, of the clinical preventive services that prudent clinicians should provide their patients in the course of routine clinical care. The recommendations are grouped by age, sex, and other risk factors. The quality of the evidence supporting each recommendation as well as the recommendations of other authorities are listed wherever possible, so that the reader may judge for him- or herself whether specific recommendations are appropriate. Some will offer criticism that the recommendations go too far, expecting busy physicians and nurses to abandon their other clinical duties to become counselors or nutritionists. It is our belief that the "new morbidity" of injuries, infections, and chronic diseases demands a new paradigm for prevention in primary care--one that includes counseling about safety belt use and diet as well as giving immunizations and screening for cancer. Others will find the Task Force recommendations too conservative. By limiting recommendations to those screening interventions, counseling maneuvers, and immunizations that have proven efficacy and effectiveness, the Task Force reaffirms the commitment to first do no harm. All possible preventive interventions have not been examined, of course; much remains to be done as research yields new data. The Guide has benefited from unprecedented cooperation--between the U.S. and Canadian Task Forces, between the Federal Government and the private sector, and between the Task Force and literally hundreds of reviewers. This in itself is a gratifying accomplishment. But the real challenge lies ahead, in the offices and clinics of busy practitioners. It is our hope that the solid scientific base provided by the Guide will facilitate efforts to meet that challenge--to improve the health of the American people through the delivery of effective services for disease prevention and health promotion. ROBERT S. LAWRENCE, M.D. Chairman, U.S. Preventive Services Task Force Harvard Medical School Cambridge, MA |