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November 26, 2003

Ethical Aspects of Recommending Lifestyle Interventions to Patients

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;290(20):2660. doi:10.1001/jama.290.20.2660-a

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 ethical responsibility.

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.13 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.

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