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Evangelists and Snails Redux: The Case of Cholesterol Screening
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, like any other untested health maneuver, may do more harm than good and must meet scientific as well as political criteria before it is implemented.”
This issue of Annals contains a guideline from the American College of Physicians on screening for cholesterol [2] and a perspective on that guideline [3], classic …
