Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
In Reply: We generally agree with Drs Sabaté
and Yach that a dynamic process of adherence requiring individualized attention,
among other factors, is necessary to enact behavioral change. We also agree
that the process of behavioral interventions by experienced and appropriately
trained clinicians is a first step in the process of motivation to change.
However, we also believe that alternative approaches to enhance behavioral
interventions should continue to be tested. Current methods to modify risk
in primary prevention involve resource-intensive efforts whose efficacy and
cost-effectiveness for reducing morbidity and mortality remains largely unknown.
Such objective information about preclinical disease in the context of an
ongoing patient-physician relationship might help to support behavioral interventions.
For example, in a subgroup of participants with cardiac calcification in our
study, there was a trend toward improved risk profile when calcification data
was included in the process of care. We suspect that the detection and presentation
of objective subclinical disease can have a motivational effect in the right
setting. This hypothesis requires further study in higher-risk, asymptomatic
populations with a higher prevalence of significant calcification.1
O'Malley PG, Taylor AJ. Screening for Coronary Calcification—Reply. JAMA. 2003;290(12):1576. doi:10.1001/jama.290.12.1576-a