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ACB-CLIN-CHEM-GEN  2000

ACB-CLIN-CHEM-GEN 2000

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Subject:

RE: Autism, etc

From:

John Whitfield <[log in to unmask]>

Reply-To:

John Whitfield <[log in to unmask]>

Date:

Tue, 3 Oct 2000 11:55:09 +1000

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (46 lines)

At the risk of stating the obvious, anyone is entitled to have a theory and 
shouldn't be criticised unduly if it seems fairly implausible ("Do you 
seriously mean to tell us, Dr Copernicus, that ................?").

It's the next bit which is difficult; before proclaiming a theory as truth 
it should be subjected to tests which are capable of falsifying it, with 
the results exposed to informed criticism through peer review and 
publication, and in the case of proposed treatments with evaluation of 
safety and of effectiveness through randomised controlled trials. All this 
costs a lot of money and takes a considerable time, but raising false hopes 
is an unkind thing to do when there is so much at stake.

As far as we (members of this mailing list) are concerned, the issue is 
when potentially/purportedly diagnostic tests should be offered. Once 
again, there should be evidence that testing can bring benefit. Because 
safety is less of an issue with testing than with treatment the standards 
can be relaxed a bit, but we still need either trial-based evidence of 
benefit or a presumption of benefit because the testing can separate 
patients into useful categories. If the tests are not yet validated in this 
way then patients/subjects/relatives should be told that the test is 
experimental and still under evaluation, and may not be of direct benefit 
to them. And in this situation they probably should not be asked to pay for 
it.

If the patients should not pay, then insurance companies or governments may 
well feel they should not pay either. In relation to drugs, the 
pharmaceutical companies pay for evaluations of their products but most 
diagnostic tests do not attract that degree of financial support (or 
ultimate financial return). One of the issues which clinical chemists must 
address is how test evaluations are to be funded; by research grant 
support, by using hospital resources, or by requiring a formal process 
before a test is approved (which will add to costs and tilt the balance of 
innovation even more towards industry)?

John Whitfield
Clinical Biochemistry
Royal Prince Alfred Hospital
Sydney, Australia

Phone (+61) 2 9515 5246
Fax (+61) 2 9515 7931




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