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Carl W. Tyler, Jr, MD; Paul V. Stange, MPH; Ray M. Nicola, MD, MHSA
Centers for Disease Control and Prevention Atlanta, Ga

JAMA. 1993;270(3):319.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.

—Dr Leaf¹ makes a powerful argument supporting preventive medicine as an essential element of the nation's health care system. His comments still leave critical questions unanswered. Among them are the following:

1. Leaf states that "any impartial examination of the evidence would indicate the need for a major change in the emphasis" to embrace cost-effective preventive measures. What realistic means can bring about the "substantial cultural changes on the part of both physicians and the public" for which he calls, particularly public acceptance of "more responsibility individually for their own health through choices they make and the life-styles they pursue"?
   
2. How should the connections between preventive medicine, public health, and clinical medicine be established so that "our ailing health care system" becomes disease-prevention and health-promotion oriented?
   
3. Our current approach to medical education may not be totally responsible for our ailing health system, but are there no changes
   

Footnotes
Edited by Drummond Rennie, MD, Deputy Editor (West), and Margaret A. Winker, MD, Senior Editor.

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