<International Circulation>：How have the risk factor controls been disseminated in hospitals and clinics in the US?

May Chen: I am not a physician， so， based on what I know – and I don’t know what goes on in hospitals – I can tell you what I do know.  We don’t have any central guidelines. Something like ‘this is a guideline to treat people with high cholesterol; if you are male do this， if you are female do that if you are certain age and with co-morbidity…’ or whatever different things.  Society should especially play a very active role in that， for example， the ACC has guidelines for a number of cardio vascular diseases.  But guidelines are just one part of the equation.  There is guidelines implementation， too.  How do you actually implement it?  Do the care institutions – the hospitals and the doctor’s practices – do they actually have all the guidelines that are available?    That’s question number one.  Question number two is adherence: do they actually do it?  Now， based on my research – and I just unearthed this the other day – that in terms of guideline adherence by practitioners – both US and UK doctors lag behind that of the Dutch doctors.  The Netherlands is known for its excellence in primary care.  And they attribute that in their consistence in their effort to promote quality of primary care based on prevention.