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In Reply: Dr Kvasnicka rightly underscores the importance of adherence rates, but his emphasis on comparing clinical interventions misses the point of the article: efforts by individuals and communities to reduce risk factors before diseases develop have greater potential to improve health than performing clinical interventions after disease processes set in.

Changing lifestyle is notoriously difficult. As Kvasnicka notes, most smokers who receive cessation advice from clinicians or pharmacotherapy continue to smoke.¹ But the limitations of clinical assistance do not change the reality that smokers can choose to quit, with or without the help of clinicians, and if all US smokers did so more than 400 000 deaths per year would indeed be prevented.²

Use of -blockers cannot save as many lives. Kvasnicka implies that my estimate of 17 000 avertable deaths factors in the failure of some patients to take the medication. In actuality, it assumes perfect adherence, with all eligible . . . [Full Text of this Article]

Steven H. Woolf, MD, MPH
swoolf@vcu.edu
Department of Family Medicine
Virginia Commonwealth University
Richmond

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