Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
In Reply: In response to Dr Veatch, physicians
have a primary responsibility to recommend the best treatment available and
to do no harm. Of course, they also have responsibilities to outline the treatment
options available and to help individuals understand the risks and benefits.
If they simply prescribe a pill, the easier task, this may not fulfill this
Expert panels recommend lifestyle changes as the foundation of treatment
for dyslipidemias.1,2 In
practice, this intervention should be pursued for 4 to 8 weeks before medication
is prescribed.2 The recommended dietary
intakes for management of elevated serum low-density lipoprotein cholesterol
include saturated fat, less than 7%; cholesterol, less than 200 mg/d (5.18
mmol/d); increased soluble fiber; and use of soy protein and plant sterols.
All of these measures independently decrease serum low-density lipoprotein
cholesterol levels.1- 3 Lifestyle
changes not only lower serum lipids but also have the benefits of decreased
risk of coronary heart disease, lower blood pressure, improved weight management,
and reduced risk of certain cancers.3 Thus,
I believe that it is irresponsible to fail to prescribe lifestyle changes.
Anderson JW. Ethical Aspects of Recommending Lifestyle Interventions to Patients. JAMA. 2003;290(20):2660. doi:10.1001/jama.290.20.2660-a