Counterpoint: to (measure apo) B or not to (measure apo) B: a critique of modern medical decision-making.
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.
Sniderman
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Mike Rosenbloom Laboratory for Cardiovascular Disease, Royal Victoria Hospital, Montreal, Quebec. asniderm@is.rvh.mcgill.cal
D001055:Apolipoproteins B / Q000097:blood*; D002784:Cholesterol / Q000097:blood; D003245:Consensus Statements as Topic; D003327:Coronary Disease / Q000097:blood; D017408:Guidelines as Topic; D006801:Humans; D006937:Hypercholesterolemia; D008075:Lipoproteins, HDL / Q000097:blood; D008077:Lipoproteins, LDL / Q000097:blood; D012015:Reference Standards; D012307:Risk Factors
D001055:Apolipoproteins B; D008075:Lipoproteins, HDL; D008077:Lipoproteins, LDL; D002784:Cholesterol