Screening is inefficient and too expensive for the NHS

doi:10.1136/bmj.a906

Published 22 July 2008, doi:10.1136/bmj.a906
Cite this as: BMJ 2008;337:a906

Letters

Death in young athletes

Screening is inefficient and too expensive for the NHS

The first 150 words of the full text of this article appear below.

Currently a resting electrocardiogram costs £35 throughthe Cardiac Risk in the Young programme. Variable penetrancefor hypertrophic cardiomyopathy with obstruction means thatone-off resting ECG screening will miss the commonest causeof sudden athletic death in people under 35 unless it is repeatedat least annually.¹

Although a combination of family symptoms, family history, andresting ECG will increase the sensitivity of a screening programme,upgrading to stress ECGs and on probably an annual basis justwon’t work on the NHS, because of cost. Thus, by definition,such a "screening" programme is ineffective.

The obvious question is what we do with the positive screeningtests. Do we truly have a right to prevent participation insport? Imagine, for example, the African runner, whose sportingprowess provides food and water for his whole village.

The Seattle experience suggests that the availability of advisoryexternal defibrillators is a positive step in . . . [Full text of this article]

Jonathan R Hanson, rural practitioner

¹ Ardvasar, Isle of Skye IV45 8RS

jthan60@hotmail.com