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Proceed With Abundant Caution

Peter D. Jacobson, JD, MPH

JAMA. 2008;299(2):208-210.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

Clinical practice guidelines (CPGs) are an integral part of medical practice and an important quality-of-care indicator. Because CPGs offer the promise of more consistent and effective health care,¹ policy makers should promote their development and use. Except in rare instances, however, support should not be transformed into legislative mandates, as was recently considered in Texas.

In July 2006, an independent group of cardiologists published the Screening for Heart Attack Prevention and Education (SHAPE) Task Force Report.² The group recommended screening of all asymptomatic men aged 45 to 75 years and women aged 55 to 75 years (except those defined as very low risk) for subclinical atherosclerosis.² Based on this controversial proposal, Texas Rep Rene Oliveira introduced legislation on February 14, 2007, to mandate that health insurers in Texas provide reimbursement for screening to detect asymptomatic atherosclerosis.³

Although the legislation was not enacted, it reportedly will . . . [Full Text of this Article]

From Guidelines to Mandate

SHAPE Guidelines

The Proposed Texas Legislation

Guidelines

Mandates

Entrepreneurial Activity

The Medical Profession's Response

Author Affiliations: Center for Law, Ethics, and Health, University of Michigan School of Public Health, Ann Arbor.

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