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Chris Sampson added The redundancy of screening trials.tex
over 9 years ago
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\section*{The redundancy of screening trials}
To capture the value of screening we do the same as for any other health care intervention; we carry out an RCT. It appears to me that screening trials are unnecessary, of little value and potentially dangerous. This may be a foolhardy suggestion given that my employment depends upon a screening trial, but I'll go on.
I'll tackle my three claims in reverse order. Firstly, screening trials are potentially dangerous. This is simply because screening is potentially dangerous. As we've already established, the value of screening is derived from the value of treatment for the disease for which an individual is being screened. If a person is screened positive, they may be able to receive treatment earlier than they otherwise would. However, it seems unlikely to me that the treatment they will receive has been evaluated in asymptomatic individuals like themselves. Trials of pharmaceuticals, surgery or other health care interventions are invariably carried out in populations with symptomatic disease. Therefore, our understanding of the benefits, costs and side-effects of the treatment may not be relevant to individuals receiving treatment after being screened positive. The effect in this population may be detrimental.
Secondly, screening trials may be of little value. Given that the value of screening is derived from the effectiveness of treatment, a change in the cost-effectiveness of the best available treatment for a disease will render the `effectiveness' results from the screening trial redundant. Studies of screening no doubt provide other important data and findings, but I do not believe `effectiveness' to be one of them\ldots (please don't fire me).
Thirdly, trials of the effectiveness of screening are unnecessary. Again because the value of screening is derived from treatment. Armed with information about the effectiveness of treatment, screening uptake and the sensitivity and specificity of the screening method, we can accurately model the `effectiveness' of screening. A trial of the effectiveness provides no new information.
