The paper on lipid screening by the American College of Physicians [1] is thought-provoking yet disappointing. The recommendations for limited screening for lipid disorders in young adults eliminates an important impetus (similar to that provided by plasma glucose levels and blood pressure) for positive lifestyle changes by young patients. Despite the lack of definitive population studies done in persons 20 to 45 years of age, an individual patient's knowledge of his or her own lipid levels and the lipid changes that are seen as a result of lifestyle changes can be used to strongly reinforce healthy lifestyle patterns and possibly to slow atherogenesis in a population in which cardiovascular disease will become the overriding cause of illness and death with age. An emphasis on lipid screening and nonpharmacologic intervention in this age group could decrease the need for pharmacologic intervention in the future. The difficulties of invoking lifestyle changes in the population as a whole should not deter health professionals from stressing the importance of these changes to individual patients. A realistic fear is that managed care organizations will use this paper to further justify limiting the use of diagnostic screening tests (such as those for plasma lipid levels) and therapies (such as dietary counseling). As patient advocates, we must use the existing literature and a measure of common sense to best manage our patients. These guidelines should be used to generate discussion and prompt further studies, but they should not be strictly adhered to.