Bandolier, as always, gives value but why has there been so little change in
the past 5 or 6 years? And are the questions being asked valid?
As the melanoma example shows we do not know how to define disease so it
becomes very difficult to measure any outcome.
Disease is an interaction between patient and 'medical' adviser. We can use
tests to predict the likelihood that the outcome of this interaction will
bear the label X or Y but that is almost as far as it goes.
What we cannot control is the placebo element and one has to ask if we
really want to. Does it really matter if the effect of acupuncture is part
placebo or even solely placebo? The challenge is to devise a treatment that
is cheap and safe and gives the patient relief, no matter why.
The message that most tests are misapplied must be heartfelt by almost all
in the laboratories. Why, therefore, do so many curricula fail to
concentrate on what one cannot deduce from data (lab or otherwise)?
Finally, are we applying laboratory tests in the best position within
decision pathways?
The performance of a test is very dependent (as the article points out) on
the question asked and the population(s) in which is applied. Is it true
that "Diagnostic testing is a source of major economic waste in health
services" or would the value of diagnostic testing be much higher if we
designated tests to be applied early in the decision tree - that is before
clinical history and examination?
Trevor Tickner,
Norwich
> -----Original Message-----
> From: Jonathan Kay [SMTP:[log in to unmask]]
> Sent: 19 February 2002 13:15
> To: [log in to unmask]
> Subject: Bandolier on "diagnostic testing"
>
> http://www.jr2.ox.ac.uk/bandolier/booth/diagnos/Diagessy.html
>
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