Pulse editor Jaimie Kaffash considers the case for screening, and the impact on GPs of celebrity-led campaigns and new at-home testing kits
As anyone who has spoken to me for more than a second would know, I am a big football fan. So I am aware that, in recent years, there have been players who have collapsed on the pitch due to heart problems, and many more who’ve had to retire as a result of conditions identified off the pitch following symptoms.
Speaking to Copperfield about this, I suggested calls for sportspeople to be screened for potentially fatal heart defects seemed sensible.
Most of you reading this probably share his reaction – that we could be ending careers needlessly, leading to overmedicalisation and mental health problems. But his stronger response was that an editor of a magazine for GPs should know better. But I am not the only health journalist/editor who has considered screening as ‘sensible’. And therein lies the problem. Because on the face of it, screening does seem like a rational idea – even to those of us who should know better.
Making a case against screening requires nuance that is tough to communicate to the public. Whereas making the case in favour is easy – pretty much all screening will (and does) save lives. It’s a compelling argument, especially if you have a decent PR budget and media-trained spokespeople.
Many – probably the majority of – screening advocates do so in good faith. They may be people involved in charity work having been personally affected, or specialists who see a high number of patients with a certain condition. But there are also those who are profiting from unofficial screening in the form of questionable private health checks, and now at-home testing kits.
Either way, the issues remain – it seems that governments have delegated their duties in this regard to GPs, who are the only ones putting their head above the parapet to warn about overscreening.
Because that caution is vital. At a time of huge demand on the NHS and increasing anxiety around personal health, the potential harms of overscreening become even greater. A call from a specialist for men over the age of 50 to contact their GP for a PSA test, or a celebrity going on morning TV to urge patients to see their doctor if they are in an at-risk group has far more impact on GPs’ working lives than most government initiatives.
Any moves to encourage well people to take tests outside of a nationally approved programme, or see their GPs because they have been unduly worried, should have a similar stigma to, say, overprescribing antibiotics or promoting unevidenced alternative therapies. Health authorities have a duty to counter the hype of unofficial screening campaigns, instead of leaving GPs to do so in unnecessary consultations.
Of course, in an ideal world, we’d focus more on preventive health. But we haven’t enough resources to provide basic care for sick people, and that has to come first.
On top of that, I’m not convinced screening is necessarily the best form of preventive health. More proven – and less expensive – public health schemes have been cut; the restoration of clinics for smoking cessation and addiction, and sexual health should be a priority when resources permit. These services also have the advantage of reducing medicalisation.
Screening does save lives on an obvious level. But banning roads or junk food, imposing curfews and removing the stress of watching Arsenal would also reduce deaths at that level – but at what cost to our quality of life?
A version of this column originally appeared in the April/May 2023 issue of Pulse