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RE: Screening for Down's syndrome

I think the Down's screening issue, and the JAMA reports on tPA in stroke, reflect the dangers of generalizing the results of research.  A given therapy or diagnostic tool needs some sort of prospective evaluation, wherever it used.  Industry constantly monitors quality, and how new tools/methods affect it.  Medicine could use the same process to avoid missing adverse or ineffective therapies.  I was glad to see the articles on tPA, come out.  Clearly, Cleveland and other sites are not having the degree of success, or lack of harm as the initial investigators.  The retrospective Down's survey points to the same issue.  Research needs to be critically appraised, then critically monitored.

Regards,
Daniel L. Sontheimer, M.D.
Asst. Prof. Of Family Medicine
Spartanburg Family Medicine Residency
853 N. Church Street Suite 510
Spartanburg, SC 29303
Email:  [log in to unmask]
References:

  1. Six year survey of screening for Down's syndrome by maternal age and mid-trimester ultrasound scans.  Howe, D. et al. BMJ 2000;320:606-610.
  2. Use of Tissue-Type Plasminogen Activator for Acute Ischemic Stroke:  The Cleveland Area Experience.  Katzan, I. et al.  JAMA 2000;283:1151-1158.

    3. -----Original Message-----
    From:   Yaser  Adi [SMTP:[log in to unmask]]
    Sent:   Friday, March 03, 2000 12:32 PM
    To:     [log in to unmask]
    Subject:        Screening for Down's syndrome

    Dear list members,
    If a screening test takes considerable time and effort to be introduced, how long does it take to remove such a screening test from practice if proved not effective? In this week in BMJ http://www.bmj.com/cgi/content/full/320/7235/606 
    (Six year survey of screening for Down's syndrome by
    maternal age and mid-trimester ultrasound scans) the authors believe that a blood
    test-serum screening was introduced without
    scientific evidence for its clinical effectiveness.
     
     
    Dr Y. Adi
    Department of Public Health
    University of Liverpool