Why I'm dead against vascular screening
Oh dear. It hasn’t worked. My policy of sticking my fingers in my ears, shutting my eyes and making a loud ‘Nnnnnnnnnnrrrrrrrrrrrrrr’ noise, that is. Because vascular screening is still happening.
Oh dear. It hasn't worked. My policy of sticking my fingers in my ears, shutting my eyes and making a loud ‘Nnnnnnnnnnrrrrrrrrrrrrrr' noise, that is. Because vascular screening is still happening.
I know, because of the headline, ‘GPs losing out to pharmacists in vascular screening lottery'
I had hoped that, when I removed fingers from ears, opened eyes and stopped making that silly noise, it would have gone away. It hasn't.
It's not the fact we're ‘losing out' to pharmacists that bothers me. It's simply the fact that this hare-brained, monumentally complicated, vastly expensive, philosophically flawed and politically driven ‘programme' is going ahead at all.
Or, to put it another way, I fundamentally disagree with Peter Holden's comment that 'nobody minds doing it fully costed'. Because I do.
Yes, I know, I'm a doctor, and I'm supposed to save people. Actually, I quite like doing that. It's converting well people to ‘ill' that bugs me. And that's what vascular screening is about: the medicalisation of a large proportion of the population.
Remember Wilson's criteria for screening? No, me neither. But I've just had a quick refresher, and I can't help noticing that criterion 9 states the risks, both physical and psychological, should be less than the benefits; and number 10 suggests that the costs should be balanced against the benefits.
All I can say is that, if you could apply a Framingham risk score to a screening programme, this one would already be in the coronary care unit. We have absolutely no idea how freaked out Joe and Josephine Public are going to be when they're given – whether they want it or not – their CV risk score. Because no-one's researched that particular question.
And as for cost-effective….all these strokes and heart attacks we're going to prevent will result in what, exactly? Shiny, happy, non-atherosclerotic people who live forever? Or an aging population which develops diabetes, chronic renal failure, cancer, prolonged pension benefits and a nice long stay in an old people's home?
Admittedly, I've only done the number crunching on the back of an envelope. But I reckon the scheme will only be cost effective if we shoot everyone on their 75th birthday, and I don't think that's the plan.
My only hope is that the current publicity given to consent for mammograms will inform consent for vascular screening.
For example, if NNTs, rather than relative risk reductions, are presented to the punters, we might be saved from NHS meltdown and mass cardiac neurosis.
So, can I rely on nurses, pharmacists and screening evangelists to cope with and employ the concept of the NNT? Nnnnnnnnnnrrrrrrrrrrrrrr…..Converting well people to ‘ill' bugs me. And that's what vascular screening is about: the medicalisation of a large proportion of the population
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