The top down approach has actually been the state of the art in America for the last 5-10 years. It has been the state of the art in Europe since at least 5 yea

The top down approach has actually been the state of the art in America for the last 5-10 years. It has been the state of the art in Europe since at least 5 years earlier than that-- And the conflict between the two schools of thought has been very interesting to observe. This study is not really net-new information, but it does add to the pile of evidence in favour of the more aggressive treatment approach. There are still a very large number of specialists who have not yet updated their views.