David Sackett's wholesale condemnation of preventive medicine is neither original nor tenable.1 For example, anti-vaccinationists have been with us for more than a century,2 but vaccination and immunization have prevailed.
The major thrust of Sackett's commentary is to rebuke the practice of “pursuing symptomless individuals and telling them what they must do to remain healthy.” Have we all been wrong in diagnosing and treating symptomless hypertension, diabetes, HIV infection, silent coronary artery disease, dyslipidemia, and incidentally discovered breast cancer and melanoma? Is Sackett implying that the various associations and institutions issuing practice guidelines and standards of practice, with the advice and consent of clinical epidemiologists and biostatisticians, are all and always wrong? The conclusions of the WHI study3 are not disputed. To generalize from it to unrelated fields is scientifically invalid and ethically wrong because it deprives patients of the potential benefit of treatment.