Lewis A. Conner Memorial Lecture. Choices that must not be made

Throughout our professional lifetimes, we are conditioned by the need to choose; among careers, among treatments for our patients, among health habits and lifestyles. After detailing the extent to which a choice-making orientation has dominated our lives, our society, our health system, our science, this paper describes areas in which it is crucial that choices not be made. These include the choice between basic and applied research, between targeted and investigator-initiated research, between prevention and treatment of cardiovascular disease, and between the need to know (research on mechanisms of disease) and the need to take action (intervention in the individual and the community to control disease). In each of these areas, a decision to emphasize either alternative at the expense of the other is undesirable and defeats the basic goals of understanding and controlling heart and vascular disease. In discussing these sets of alternatives, the three major cardiovascular risk factors are discussed: cigarette smoking, high blood pressure and diet. Examples are chosen from research investigations on risk, intervention, treatment, prevention and community control.