Twenty years ago Geoffrey Rose used the examples of blood pressure and cholesterol to show that shifting the distribution curve of a single risk factor by a small amount in an entire population has a greater effect on death rates than does treating only people with high levels of that risk factor.1 2 Rose did not entirely discount screening and treatment, but he cautioned that it should target people at high risk of developing an adverse health outcome rather than people with a single raised risk factor such as cholesterol concentration. In the case of coronary heart disease, medical practice has evolved to include assessment of the baseline risk of disease when recommending drug treatment. Rose's argument that a population based strategy reduces more deaths from coronary heart disease than drug treatment should be re-evaluated now that the medical treatment has incorporated the high baseline risk strategy.