Canadian Medical Association Journal 1996; 154: 1463
In an editorial beginning on page 1510 [abstract] Dr. Andreas Laupacis highlights three aspects of Marshall's argument that point to ways in which enthusiasm for preventive therapies might be moderated: giving close attention to how results are reported, increasing patient involvement in decision making, and making judicious use of evidence-based clinical practice guidelines.
Although we can gain a more accurate understanding of benefit, the harm of prevention, specifically its potential to induce fear, has yet to be reckoned with. It seems that we need to be alert to conflicting messages about prevention. For example, it is hardly surprising that some women, sensitized by years of publicity on breast cancer prevention, refuse hormone replacement therapy because of its association with a slightly increased risk of breast cancer. Moreover, physicians and patients seem to have different perspectives on the concept of risk. For the physician, risk is largely a mathematical construct; for the patient, it represents the potential for catastrophe. The fear generated by preventive strategies must be explored further if we are to discover how best to address it.