Some Pitfalls in Disease Screening-Reply

In Reply. — I am concerned about their conclusion that screening programs should not attempt to reach all potential participants since "such efforts appear to bring out the most "fragile subjects." I would hope that readers of our article would conclude the opposite; that is, more extensive efforts need to be made to screen people for high blood cholesterol—especially given the very high prevalence of people who are unaware of their cholesterol level—and that our recommendations might serve as guideposts for the design of summary and referral protocols that will attenuate labeling effects. While we certainly do not condone coercive efforts to recruit participants for blood pressure, cholesterol, or any type of risk factor screening program, well-designed programs should reach as broad an audience as possible. Without such a goal, the more laissez-faire approach recommended by Drs Rudd and Fortmann will lead us to the dilemma of having "hard to