Argued that Pillow et al. (1991) may have overestimated the benefits of mediational screening and underestimated the costs involved in the procedure. The three benefits they suggest: increased statistical power to detect prevention effects, increased cost-effectiveness, and decreased iatrogenic effects are shown to be modest at best. Costs associated with misclassifying people as either false positives or false negatives are considered in the total cost/benefit analysis of mediational screening. Because we cannot accurately predict who will react to the occurrence of life stress by developing the conditions we are interested in preventing, universal interventions are advocated.