14 October 2013

Is All the Dementia Screening Necessary?

Before getting into this blog, I would like to include some points that the World Health Organization (WHO) has in their guidelines about assessing the value of a screening test.

#1. The condition should be an important health problem.
#2. There should be a treatment for the condition.
#3. Facilities for diagnosis and treatment should be available.
#4. There should be a latent stage of the disease.
#5. There should be a test or examination for the condition.
#6. The test should be acceptable to the population.
#7. The natural history of the disease should be adequately understood.
#8. There should be an agreed policy on whom to treat.
#9. The total cost of finding a case should be economically balanced in relation to medical expenditure as a whole.
#10. Case finding should be a continuous process, not just a “once and for all” project

The above are guidelines worthy of remembering and applying to many topics about screening. In the US, professional medical organizations and government agencies are making the determination of what screenings should be accomplished and many times when they are to be done. In my research, I have not discovered where the WHO says to harm patients to do the screening, create a stereotype that mandates screening, or order very costly screening for the sake of screening with little or no scientific evidence to back the screening.

Yet we have screenings happening based on the three items mentioned above that professional organizations and government agencies think need to be done. Other types of screening are not done because government is not mandating them and many of the doctors would not be current enough to know what to do if the screening result was positive.

The latest screening being mandated seems to be for dementia. This screening includes all types. I have to agree with one author that many of these screenings are poorly designed, poorly thought through, and often damaging or harmful to the frailest patients. However, with the government behind this and several of the medical associations, this will be difficult to stop.

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