HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (17) Citing Articles via Google Scholar Google Scholar Articles by Sniderman, A. D. Search for Related Content PubMed PubMed Citation Articles by Sniderman, A. D. Related Collections Laboratory Management Evidence Based Laboratory Medicine and Test Utilization Lipids, Lipoproteins, and Cardiovascular Risk Factors

Counterpoint To (measure apo)B or not to (measure apo)B: a critique of modern medical decision-making

Mike Rosenbloom Laboratory for Cardiovascular Disease, Royal Victoria Hospital, 687 Pine Ave. West, Montreal, Quebec, H3A 1A1. Fax 514-982-0686; e-mail asniderm{at}is.rvh.mcgill.ca

The measurement of apo B provides critical information that is complementary to that provided by the plasma and lipoprotein lipids for the assessment of coronary risk and the choice of appropriate pharmacological therapy. Why then is this measurement not in more widespread clinical use? I suggest two explanations. First, against the evidence, there is a lingering perception that problems persist in its measurement in routine clinical practice. Far from this being the case, however, the measurement of apo B has met every reasonable standard of laboratory precision and reliability to allow its widespread introduction in clinical laboratories. The second impediment is that the introduction of new tests has become subject to the authority of consensus conferences, a new approach to medical decision-making. The number of such conferences is increasing astronomically, and their reports are major determinants of clinical practice and allocation of resources. Notwithstanding the benefits they have brought, here I argue that, just as with any other scientific method, the merits of this new method of decision-making need to be examined critically; for if we do not, a process that was established to introduce change may, in fact, retard it or destroy it altogether.

The following articles in journals at HighWire Press have cited this article:

				I. Shai, E. B. Rimm, S. E. Hankinson, G. Curhan, J. E. Manson, N. Rifai, M. J. Stampfer, and J. Ma Multivariate Assessment of Lipid Parameters as Predictors of Coronary Heart Disease Among Postmenopausal Women: Potential Implications for Clinical Guidelines Circulation, November 2, 2004; 110(18): 2824 - 2830. [Abstract] [Full Text] [PDF]

				R. Jiang, M. B. Schulze, T. Li, N. Rifai, M. J. Stampfer, E. B. Rimm, and F. B. Hu Non-HDL Cholesterol and Apolipoprotein B Predict Cardiovascular Disease Events Among Men With Type 2 Diabetes Diabetes Care, August 1, 2004; 27(8): 1991 - 1997. [Abstract] [Full Text] [PDF]

				S. M. Grundy Low-Density Lipoprotein, Non-High-Density Lipoprotein, and Apolipoprotein B as Targets of Lipid-Lowering Therapy Circulation, November 12, 2002; 106(20): 2526 - 2529. [Full Text] [PDF]

				S. M. Grundy Non-High-Density Lipoprotein Cholesterol Level as Potential Risk Predictor and Therapy Target Arch Intern Med, June 11, 2001; 161(11): 1379 - 1380. [Full Text] [PDF]

				J. R. Crouse III and C. D. Furberg Treatment of Dyslipidemia : Room for Improvement? Arterioscler. Thromb. Vasc. Biol., November 1, 2000; 20(11): 2333 - 2335. [Full Text] [PDF]

				I. Jungner, S. M. Marcovina, G. Walldius, I. Holme, W. Kolar, and E. Steiner Apolipoprotein B and A-I values in 147 576 Swedish males and females, standardized according to the World Health Organization–International Federation of Clinical Chemistry First International Reference Materials Clin. Chem., August 1, 1998; 44(8): 1641 - 1649. [Abstract] [Full Text] [PDF]