This move by the german government is not wise and not based on sound evidence. I guess the idea behind it is to foster a health conscious living which is per se a good idea, however, the proposed measure is totally inadequate. It might be debatable to offer a bonus for those who participate in screning but not a pentalty for those who don´t. The new law is now up for disussion in parliament and we try to convince politics that this is the absolute wrong way,
greetings from Berlin
Bernhard Gibis
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Dr. Bernhard Gibis, MPH
Kassenärztliche Bundesvereinigung
Dezernat 2 - Versorgungsqualität und Sicherstellung-
Herbert Lewin Platz 2
10623 Berlin
Telefon: 03040051201
Fax: 0304005271201
email: [log in to unmask]
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www.kbv.de
www.damit-ihnen-nichts-fehlt.de
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-----Ursprüngliche Nachricht-----
Von: Evidence based health (EBH)
[mailto:[log in to unmask]]Im Auftrag von k.hopayian
Gesendet: Donnerstag, 2. November 2006 09:34
An: [log in to unmask]
Betreff: Coercion in screening
Legislation is being planned in Germany to coerce people, through financial
penalties, to take part in screening procedures. You can read the news story
at:
http://bmj.bmjjournals.com/cgi/data/333/7574/877-c/DC1/1
In brief, the following groups of people will have to make higher
co-payments if they do not take up screening and then develop the
associated cancer:
1 Women who have not had annual cervical smears from the age of 20
2. Women who have not had annual breast examinations from the age of 30 and
mammography every 2 years between the ages 50-69
3. Men who do not have annual digital rectal examination of the prostate
from the age of 45
4. All adults who do not participate in annual faecal occult blood testing
from the age of 55 and have two colonoscopies, ten years apart.
Does it matter to us who makes decisions about health care? I believe that
it does. The role of evidence in evidence-based health care is to INFORM
decisions. What "appears" to be true is not an immediate prescription for
what should be done. Practitioners and health service organisations should
guide but should not coerce. Coercion runs counter to the ethics of
evidence-based health care. As the Sicily Statement says:
"These decisions [about health care] should be made by those receiving care,
informed by the tacit and explicit knowledge of those providing care, within
the context of available resources."
The planned legislation also breaks with another ethical principle: the duty
to give information based on the best available evidence and a qualification
of the strength of that evidence. Many of the screening programmes above are
not backed up by sound evidence. Where evidence does exist, for example
mammography, interpretation of the evidence is controversial.
--
B/W, Kev Hopayian
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