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Gold, incentives and meh

GPs shun call for FH screening

A call to screen children for familial hypercholesterolaemia (FH) when they attend for their first MMR vaccination has been criticised by GPs.

Researchers from London's Wolfson Institute of Preventive Medicine argued in this week's BMJ that screening at about 15 months would allow detection and treatment of FH which affects two in every 1,000 people.

Identifying an affected child would also help identify a parent with the disorder.

Taking a blood spot at the same time as the 13-month MMR vaccine would be an ideal opportunity, they said.

But Dr Mike Kirby, a GP in Hertfordshire and professor of health and human sciences at the University of Hertfordshire, said: ‘The resource implications of carrying out this sort of screening are huge for a relatively rare condition.

‘I would think identifying and screening family members of someone with FH is a far more cost-effective approach.'

Dr Anthony Harnden, a GP in Wheatley, Oxfordshire with a special interest in paediatrics, said ethical issues had to be considered. ‘I would question whether it is ethically acceptable to do screening which tests one individual, but actually has the primary purpose of identifying a disorder in another.'

Lead author and consultant cardiologist Dr David Wald conceded that the screening test would identify a problem in babies who would not be able to be treated until adulthood, but insisted it would mean they could be regularly monitored until old enough for lipid lowerers.

He also acknowledged there would be practical challenges and said: ‘That's why we think the next move would be to set up a limited implementation pilot focusing on the best way to offer screening.'

NICE currently has a group working on an FH guideline due out next summer, but population screening will not be considered.

Dr Sunil Bhanot, a GP in Tadley, Hampshire, and a member of the UK National Screening Committee, confirmed that FH screening was not a part of current discussions.

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