Niemi et al's (Reference Niemi, Suvisaari and Haukka2004) report does not truly address the implications of their findings. Their clinical implications (p. 16) summarise their results, but one fails to draw clinical sense of it or be in a position to use the information in clinical practice. One could be cynical about their findings; the offspring of mothers with schizophrenia or psychotic disorders are expected to be at increased risk, which could vary across studies owing to a multitude of factors, so the findings of the study are no surprise. The increased risk could be genetic, psychosocial or both.

The clinical implications of high-risk studies ought to help identify those at high risk and prevent health problems in them. A number of studies on risk reduction strategies have been reported for common medical problems, including diabetes (Parillo & Ricardi, 2004), cardiac disorders (Reference FerdinandFerdinand, 2004) and atherosclerotic vascular disease (Reference Heckam and AnandHeckam & Anand, 2003) and even complex multi-factorial disorders such as hypertension (Reference Sheridan, Pignone and DonahueSheridan et al, 2003), to name a few. Although little can be done about the genetic component of the risk, the psychosocial and environmental effects can definitely be minimised. Multiple appropriate lifestyle alterations and stress protective strategies may be relevant. Furthermore, one expects that over time, the more recent studies should report relatively lower rates of elevated risk compared with those done decades earlier. Incidentally, Niemi et al found an incidence of 6.7%, lower than the 16.2% found in a study reported in 1993, and 13.1% in one reported in 1995, showing a gradually decreasing receding trend. Niemi et al attribute these differences to methodological factors, but one wonders whether the reduction can be attributed to preventive measures being implemented with those at high risk, advertently or inadvertently.

What is the point of knowing that people are at increased risk of developing a disorder if nothing can be done with this knowledge?