Individually based preventive medical recommendations – are they sustainable and responsible? A call for ethical reflection

Estimating the high risk group for cardiovascular disease in the Norwegian HUNT 2 population according to the 2003 European guidelines: modelling study

“…Evidence from biomedical research has limited meaning in isolation; it must be regarded in light of the overall vision, values, strategies, and resources that exist in the area of preventive medicine, both nationally and internationally 22 – 24. Despite the contribution of numerous experts and professional societies, it seems that authoritative clinical guidelines on the basis of the systematic coronary risk evaluation project may be an example of premature application of medical technology in routine clinical practice.…”

Exercise on prescription in general practice: A systematic review

“…'Exercise on Prescription' (EoP) interventions are used in general practice in several countries in an attempt to initiate a physically active lifestyle among sedentary patients with signs of lifestyle diseases. However, some believe that EoP interventions will require too many resources in primary care if applied to everybody at risk [3]. This review defines EoP as personalized secondary prevention located in primary healthcare involving the general practitioner (GP) or other primary healthcare staff.…”

Can individuals with a significant risk for cardiovascular disease be adequately identified by combination of several risk factors? Modelling study based on the Norwegian HUNT 2 population

“…One of the reasons may be that the target group was so vast. It has been calculated that literal adherence to the Green prescription initiative could in fact consume half of all consultations in Norwegian primary health care [32].…”

“…Definition of relevant and clinically meaningful cut‐off levels for individual risk intervention is crucial in this connection. We believe that it can be demoralizing and alienating for primary health care professionals to feel obliged to inform a large majority of the individuals they serve that their current cardiovascular health is not ‘good enough’ according to biomedical standards [32]. The prospect of thus ‘medicalizing’ a large majority of an adult population such as the one in Norway, with one of the world's longest‐living and healthy‐living populations according to WHO statistics [1,16], evokes several epistemological and ethical challenges [15].…”