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Labelling people as ‘High Risk’: A tyranny of eminence?
  1. Teppo L N Järvinen
  1. Correspondence to Professor Teppo LN Järvinen, Clinical Medicine/Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Central Hospital, Töölö Hospital/Topeliuksenkatu 5, Helsinki 00014, Finland; teppo.jarvinen{at}

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Whenever a doctor cannot do good, he must be kept from doing harm.Hippocrates

Nowadays, being at ‘high risk’ of having a disease has become a disease in and of itself. Sweeping educational programmes at all levels of healthcare now turn an otherwise healthy person's ‘high’ blood pressure, elevated serum lipids or low bone density into chronic conditions having increased risk of a potentially bad event.1 But what represents ‘high risk’? This question lies at the heart of modern medicine, particularly with respect to pharmacological primary prevention.

Advocates of this evolution argue simply that primary prevention saves lives. However, permissive labelling of conditions as diseases may not be entirely harmless. On an individual patient level, possible disadvantages include making relatively healthy individuals perceive themselves as ‘sick’, and almost every treatment has inherent risks.2 On a societal level, we probably all still remember the discouraging effect of the new European guidelines on cardiovascular disease classified most adult Norwegians—among the healthiest populations in the world—to be at ‘high risk’ of cardiovascular disease.3 …

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