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Advisors sidelined over screening

The NHS these days is an evidence-based beast.

The NHS these days is an evidence-based beast.

GPs are bombarded with information from prescribing advisers, drug regulators and the omnipresent NICE on what works, what doesn't and when we're not sure.

The old medicine, of anecdote and intuition, is now old hat.

And fair enough – except that not everyone plays by the new rules.

Evidence is critical when deciding whether NHS cash should be frittered away on an expensive new drug, but somehow less important when considering whether to plough millions into the latest political whimsy.

There's no better example than screening.

Earlier this year, Gordon Brown announced plans for a huge expansion in NHS screening, with GPs to lead on the detection and treatment of an array of chronic diseases.

Cardiovascular screening alone will almost triple diagnoses of chronic kidney disease, nearly double diagnoses of diabetes and pick up millions with what is now labelled pre-diabetes for good measure.

There are plans to screen for COPD too, with prevalence of this illness also likely to double.

Sparse evidence

All these programmes will greatly increase GP workload, soak up NHS resources like vast sponges and medicalise millions.

But that, in itself, is no reason not to do them. If the expense is paid back in improved quality of life and lives saved then few people, and certainly not GPs, will complain.

The problem is that the evidence for the benefits of screening is sparse at best, and the Government appears to have circumvented its own advisers in going ahead.

At least one member of the National Screening Committee has spoken out against the planned cardiovascular screening programme, and there are claims such scepticism represents the committee's majority view.

Ministers increasingly appear to be promoting screening not because of evidence of benefit to patients, but through a perception it is popular with voters. But do electoral whims really have a place in an evidence-based NHS?


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