Drs Knishkowy and Palti1 present an excellent review of the recommendations of the American Medical Association Guidelines for Adolescent Preventive Services (GAPS). The authors point out that many of the 24 clinical preventive service recommendations, and all those that target behaviorally related health risk reduction, are based predominantly on expert opinion. They also question the justification for the complete physical examination that is recommended 3 times during adolescence, the reasons for excluding certain topics, and the practicality of annual visits.
All these issues and other thoughtful questions that have been raised since the release of GAPS more than 5 years ago help refine comprehensive preventive services for adolescents. Our belief as we started the GAPS project, and one that we feel even more strongly about today, is that health professionals and administrators need a vehicle for organizing the content and provision of preventive services for adolescents. There is little