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In Reply: In response to Dr Falk and colleagues, as a nonspecialist I cannot comment on the merits of any particular screening mechanism or the coronary artery calcium score vs the Framingham Risk Score as a better predictor of coronary artery disease. However, I take issue with their statement that "the proposed Texas legislation incorporates what we consider to be the most accepted part of the SHAPE guidelines." Accepted by whom and under what circumstances? Are they conceding that the guidelines as a whole have not been accepted as professional consensus through the peer-review process? Most importantly, should legislators determine which aspects of guidelines should be mandated and which should not?

What is missing from their letter is a compelling reason why the legislature should be involved. For example, is there evidence that insurers are refusing to cover the specific tests the SHAPE guidelines are designed to encourage?¹ Is there . . . [Full Text of this Article]

Peter D. Jacobson, JD, MPH
pdj@umich.edu
Center for Law, Ethics, and Health
University of Michigan School of Public Health
Ann Arbor

RELATED LETTER

Legislating Screening for Atherosclerosis
Erling Falk, Morteza Naghavi, and P. K. Shah
JAMA. 2008;299(18):2147-2148.
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