© 2004 BMJ Publishing Group & Royal College of Paediatrics and Child Health
COMMENTARY
Screening
Screening for coeliac disease: what evidence is required before population programmes could be considered?
MRC Epidemiology Unit, Cambridge, UK
Correspondence to:
Correspondence to:
Dr N J Wareham
MRC Epidemiology Unit, Strangeways Research Laboratory, Worts Causeway, Cambridge CB1 8RN, UK; njw1004@medschl.cam.ac.uk
Commentary on the paper by Tommasini et al
Keywords: coeliac disease; screening
| The first 150 words of the full text of this article appear below. |
In the traditional doctor-patient consultation, the patient initiates a visit and the physician’s imperative is to respond to the best of his or her ability. However, in a screening programme, the initiation comes from health professionals, and many commentators have argued that this poses different ethical challenges.1 In particular it is argued that the level of evidence concerning the balance of overall benefit and harm from the screening programme must be much greater than that for a traditional therapeutic intervention.
Although screening may intuitively be logical for a particular condition which is prevalent and detectable in the preclinical stage, intuition is not an appropriate basis for commencing a screening programme. A number of criteria have been described that allow the evidence for screening programmes to be more formally evaluated.2 Calls are regularly made for the introduction of population screening programmes, such as that for coeliac disease (CD) in the
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