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All screening has a cost

I was interested to read your story on NICE's new diabetes screening guidelines (GPs asked to mass-screen all patients aged 40 years or older for diabetes).

Sir Muir Gray, a recognised authority on screening, is fond of pointing out that all screening causes harm – meaning that although there may (or may not) be an overall benefit from a screening programme, some individuals will invariably suffer a disservice, for instance due to the side effects of investigating false positives. It is up to us to predict who might be harmed, how and by how much.

Yet the new NICE guidelines seem devoid of any impact assessment like this. If this was a new pill we were debating, Professor Kamlesh Khunti and his team would be lambasted from all sides.

Will they show us their costing methodology and risk analysis?

From Dr Lester Russell, Portsmouth

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