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Dear Jeremy
CEA carcinoembryonic antigen was suggested as a screening tool based on a diagnostic study comparing those with cancer with medical students (it looked good in that setting) however when tried
in the community lots of false positives as expected and now it is only used to monitor known ca bowel. It was the classic case of lack of spectrum of disease and i think written up in Alvin feinsteins book clinical expidemiology. It was also referred to
in the original mcmaster papers on clinical epidemiology rounds CMAJ (early 80s) diagnosis
Bruce
Bruce Arroll MBChB, PhD,
FNZCPHM, FRNZCGP
Professor and Elaine Gurr Chair in General Practice
University of Auckland
Private Bag 92019
Auckland
New Zealand
ph 64-9-9236978
fax 64-9-3737624
Physical address
School of Population Health room 378 building 730
Tamaki Campus
Corner Morrins and Merton Rd
Glen Innes
Auckland
From: Evidence based
health (EBH) [mailto:[log in to unmask]] On Behalf Of Jeremy Howick
Sent: Tuesday, 3 April 2012 11:18 p.m.
To: [log in to unmask]
Subject: Diagnosis
Hi,
There are well-known examples of therapies that were not evidence-based and were shown to be harmful (treating stroke with leeches applied to the anus, treating ventricular
arrhythmias after myocardial infarction with antiarrhythmic drugs, etc.)
I'm looking for parallel examples of diagnostic tests or strategies that have been introduced without sufficient evidence and subsequently were revealed to be useless
or harmful when the tests were rigorously evaluated in unbiased tests.
Jeremy