The causes of many health behaviors are deeply rooted in our culture, and using a counseling model that assumes individual control and responsibility for these behaviors can cause patients to feel hectored instead of helped.
Diethylstilbestrol (DES) was widely used in the 1940s to 1960s to prevent pregnancy loss but was later found to be associated with adverse health effects in exposed offspring, underscoring the need for careful evaluation of new therapies.
AMA J Ethics. 2015;17(9):865-870. doi:
10.1001/journalofethics.2015.17.9.mhst1-1509.
Those charged by the ACA health reform act to identify best clinical practices that are evidence-based and applicable across diverse populations can learn much from the experience of the Medicare-funded End Stage Renal Disease Program.