Making Sense of Testing
Leading medical bodies, clinicians and scientists are alerting the public and policy makers to the potential damage caused by health tests and scans for well people and the need for a national system to evaluate laboratory tests.
Despite the huge deployment of established laboratory tests , and the unprecedented explosion in new technologies and marketing of testing to healthy people , there is still no system (equivalent to the British National Formulary for drugs) to provide doctors or patients with evidence on performance and usefulness.
In a guide published today, GPs and scientists warn the public:
- Most tests weren’t designed for well people
- Many tests are not researched or adequately regulated
- Tests are only one part of diagnosis
- Testing can cause harm, especially in well people
The public guide , Making Sense of Testing is published by Sense About Science with the Association of Clinical Biochemistry, the PHG Foundation and the Royal College of Pathologists.
The guide is launched in conjunction with a report, The Evaluation of Diagnostic Laboratory Tests and Complex Biomarkers, from an expert summit hosted by the PHG Foundation and the Royal College of Pathologists. This report calls for:
- A national system to evaluate diagnostic tests
- A publicly accessible database to provide evidence of performance and usefulness
- Policy makers to decide who is responsible for gathering evidence and meeting the costs
In a parliamentary briefing on Tuesday they will tell parliamentarians and policy makers that this is now vital. It will improve services in the NHS and will help the public and doctors to determine the value and safety of private testing and over-the-counter products in the face of heavy promotion.
The publication of these documents follows a Wellcome Trust study and a Science Council report pointing to the lack of a structure for assessment and implementation of new diagnostic technologies in the NHS.
Comments
Dr Margaret McCartney, GP: “The advertising for private tests such as CT body scans for a ‘check-up’ can be very alarmist. People are not getting fair information about the lack of evidence for these scans doing more good than harm - or about the uncertainties and dilemmas they can result in.”
Tracey Brown, Director of Sense About Science: “Our jaws dropped when we first heard the inside track from doctors and pathologists about the high risks and dubious benefits of some of the tests people are buying. It was so at odds with public discussion. This guide to misconceptions has come out of their hard work to share their reasoning about testing with the rest of us.”
Dr Keith Hopcroft, GP: “Tests represent medicine’s snake in the grass. The public is not aware of the potential danger of indiscriminate testing so it runs the risk of treading where it shouldn’t and getting a nasty - or even lethal - bite. People realise they need to weigh up the pros and cons before popping pills or having an op, and they should adopt the same approach with tests.”
Dr Danielle Freedman, Chair, and Specialty Advisory Committee on Clinical Biochemistry for Royal College of Pathologists: “The public buy ‘testing kits’ over the counter and via the internet without knowing the limitations of their results. There are ‘cowboys in vans’ on the high street offering for a price a wide range of tests. Do the public know whether tests are performed to the same quality standards as laboratories routinely providing this service to both the NHS and private sector?”
Dr Andrew Green, GP: “Nobody should arrange their own medical tests. If you don’t have symptoms, then very few tests are worthwhile, and those that are can be had through your doctor. If you do have symptoms, you owe it to yourself to make sure the right tests are done, and properly interpreted.”
Professor Peter Furness, Vice-president of the Royal College of Pathologists: “Market forces only work if consumers can judge the quality of what they are getting. But even professionals find it difficult to assess the quality and usefulness of medical tests. To base an important decision only on one-sided marketing hype is surely a recipe for disaster. We need an independent system to evaluate all these tests, with its results published and easily available to everyone.”
Dr Ron Zimmern, Executive Director of PHG Foundation: “In the UK, around 1 billion laboratory tests are performed each year. NHS laboratories have sophisticated systems to ensure the technical accuracy of the tests, but no systems for ensuring that individual tests are clinically effective and useful. This is akin to pharmaceutical companies having tight control over the chemical purity of drugs, but there being no formal requirement for them to prove that the drugs produce any benefit for patients.”
Diana Garnham, Chief Executive of the Science Council: “The Science Council report made a clear case for a need for systematic and significant improvements in the way diagnostic technologies are introduced, evaluated, and expanded in the NHS and other healthcare settings. Diagnostic technologies will be crucial to the NHS in the next ten years if it is to meet its ambitions to have a positive impact on patient care pathways and outcomes, delivering the right care, in the right way, and as fast as possible.”
Dr Evan Harris, Liberal Democrat Science Spokesman: “At a time when the NHS can not afford to provide even all those carefully evaluated tests and treatments that are known to save or improve lives, it can not be right for there to be a “free-for-all” on tests which are of dubious value and require the NHS to spend scarce resources investigating or reassuring the worried-well. It is time for better regulation of such tests.”
Professor Stephen Holgate, Chair of the Science Council’s Science in Health Group: “After an extensive survey of the current situation, we see the need for an NHS wide integrated approach so that the very best technologies can be introduced and tested on patient pathways in a timely manner, and real effort can be made on removing outdated practice and replacing it with tests that not only improve diagnostic precision but also help patients arrive at this point earlier and more easily.”
Coverage
Fears over DIY health tests boom
Do-it-yourself tests kits ‘could put health at risk’
Scientists urge more regulation of DIY kits for health checks
Health ‘MoT’ tests are misleading and can be harmful, experts say
The public guide, Making Sense of Testing is published by Sense About Science with the Association of Clinical Biochemistry, the PHG Foundation and the Royal College of Pathologists.
The guide is launched in conjunction with a report, The Evaluation of Diagnostic Laboratory Tests and Complex Biomarkers, from an expert summit hosted by the PHG Foundation and the Royal College of Pathologists.
Last updated: March 12 2008
