Evangelists and Snails Redux: The Case of Cholesterol Screening
Authors: Frank Davidoff
Journal: Annals of Internal Medicine (1996)

Editorials1 March 1996Evangelists and Snails Redux: The Case of Cholesterol ScreeningFrank Davidoff, MDFrank Davidoff, MDEditorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-124-5-199603010-00011 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Controversy commonly surrounds the detection of disease. Some 20 years ago, Sackett and Holland [1] suggested that this controversy stems largely from the ideologic differences between "advocates" versus "methodologists," or, as they later called them, "evangelists" and "snails." Thus, evangelists hold that "the pre-existing evidence plus commonsense—in the face of the ongoing toll of disability and untimely death—demand massive screening programs for the detection of citizens with risk factors for these disorders now, even in the absence of experiments to determine whether the alteration of many risk factors will, in fact, alter risk." Snails, in contrast, are convinced that "screening, ...References1. Sackett DL, Holland WW. Controversy in the detection of disease. Lancet. 1975; 2:357-9. Google Scholar2. Garber AM, Browner WS, Hulley SB. Cholesterol screening in asymptomatic adults, revisited. Ann Intern Med. 1996; 124:518-31. Google Scholar3. LaRosa JC. Cholesterol agonistics. Ann Intern Med. 1996; 124:505-8. Google Scholar4. Davidoff F. Asymptomatic carotid stenosis: the glass is half occupied [Editorial]. Ann Intern Med. 1995; 123:729. Google Scholar5. Glasziou PP, Irwig LM. An evidence-based approach to individualising treatment. BMJ. 1995; 311:1356-8. Google Scholar6. Fisher R, Ury WL. Getting to Yes. Negotiating Agreement without Giving In. New York: Viking/Penguin; 1991. Google Scholar Author, Article, and Disclosure InformationAffiliations: Editor PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoCLINICAL GUIDELINE, PART 1: Guidelines for Using Serum Cholesterol, High-Density Lipoprotein Cholesterol, and Triglyceride Levels as Screening Tests for Preventing Coronary Heart Disease in AdultsCLINICAL GUIDELINE, PART 2: Cholesterol Screening in Asymptomatic Adults, Revisited Alan M. Garber , Warren S. Browner , and Stephen B. Hulley Cholesterol Agonistics John C. LaRosa Metrics Cited ByUncovering Mechanisms of Theory Development in an Academic Field: Lessons from Leadership ResearchProstate cancer and coronary heart disease: correlation or coincidence?Management of dyslipidemias in the age of statinsConflicts between Commercial and Scientific Interests in Pharmaceutical Advertising for Medical JournalsAre men with lower urinary tract symptoms at increased risk of prostate cancer? A systematic review and critique of the available evidenceAssociation of Coronary Heart Disease Risk Factors With Microscopic Qualities of Coronary Atherosclerosis in YouthClinical practice guidelines: reality bitesTalking about TreatmentJohn F. Steiner, MD, MPHSCREENING FOR CARDIOVASCULAR DISEASEDeterminants of atherosclerosis in the youngFrom practice to research: The case for criticism in an age of evidenceDeterminants of cholesterol screening and treatment patternsEconomic evaluation of cholesterol-related interventions in general practice. An appraisal of the evidenceEffects of Serum Lipoproteins and Smoking on Atherosclerosis in Young Men and WomenThe American College of Physicians Versus the National Cholesterol Education Program: Should Endocrinologists Listen?Trends in cholesterol testing in general practice 1 March 1996Volume 124, Issue 5Page: 513-514KeywordsCholesterolDecision makingDisabilitiesFallsHealth careMedical risk factorsPopulation statistics Issue Published: 1 March 1996 CopyrightCopyright © 1996 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...