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NEWS: Susan Mayor UK experts call for national system to evaluate diagnostic tests BMJ 2008; 336: 575-a [Full text]

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Plain Films

Stephen LITTLEFAIR   (14 March 2008)

Self-testing: self-care or self-harm?

Helen M Pattison, Sue Wilson, Richard McManus, Angela Ryan, Sheila Greenfield, David Fitzmaurice, and John Marriott   (21 March 2008)

Plain Films 14 March 2008
Stephen LITTLEFAIR, Reporting Radiographer (retired) Ex peterborough NHS trust pe1 8ge Send response to journal: Re: Plain Films	At least 50% of plain film requests for radiography are made because of defensive medicine, habit or lack of clinical expertise. This abuse of diagnostic testing has long been overlooked Competing interests: None declared
Self-testing: self-care or self-harm? 21 March 2008
Helen M Pattison, Reader in Health Psychology School of Life and Health Sciences, Aston University, Birmingham, B4 7ET, UK, Sue Wilson, Richard McManus, Angela Ryan, Sheila Greenfield, David Fitzmaurice, and John Marriott Send response to journal: Re: Self-testing: self-care or self-harm?	We welcome the debate stimulated by the two reports summarised here, particularly in relation to point-of-care testing and self-testing. It is worrying that regulation of in-vitro diagnostic and other medical devices seems to have decreased in UK. Whereas the US Food and Drug Administration ensures that medical devices are assessed on efficacy and complexity as well as safety, no official body in the UK demands such assessment, as Tom Walley has pointed out in his editorial, Evaluating Laboratory Diagnostic Tests. (1) Turning to the issue of self-testing, what is missing from the Sense about Science report (2) is the user’s perspective. We have been conducting research in this area and are investigating not only what tests are available (3) but also the characteristics of those who use self-tests and their motivations.(4;5) We feel that there is much to be gained from understanding why people choose to engage in these behaviours. Self- testing can be seen as part of the development of a changing health care context where government policy (expressed, for example, in the White Paper ‘Choosing Health’) supports and encourages individual initiative in preventative health care and a general shift towards self-management and self-monitoring of chronic illness. In this ‘self-care culture’, people are being expected to take more responsibility for their own health and are being given more control over access to information about their healthcare. NHS Direct, drop-in health centres on the high street, and health sites on the Internet are other manifestations of this movement. It can be difficult for patients to understand why doctors recommend that they should, for example, monitor their own blood sugar levels, but not use any of the other tests available to monitor their health for example HIV, prostate or cholesterol tests. Unless there are clear and widely available guidelines about why some tests may be beneficial but others are of little value to particular individuals, then advice to avoid self- testing will be seen as contradictory and is likely to generate confusion. The innovative nature of some of the in-vitro diagnostic tests on the market should not blind us to the fact that the public currently use a variety of devices to measure their health including weighing scales, thermometers and pregnancy tests. We have some preliminary evidence that self-testing is likely to grow as younger generations become more comfortable with information technologies.(6) It is salutary to remember that pregnancy self-testing was greeted with reservation when it first became available,(7) but as its use has become widespread it has improved in reliability, accuracy and ease of use, and has superseded testing by a healthcare professional in many cases. There is scope for education of the public about the safe and efficacious use of self-testing, and for more effective regulation of tests that are available in the UK market- place. However rather than rejecting self-testing as harmful per se, we believe that doctors and other health professionals need to be aware that some members of the public are using self-tests, and that they should encourage them to share this information and their motivations with them. This partnership in self-care could, and perhaps should, be the hall mark of 21st century healthcare. 1 Walley T. Evaluating laboratory diagnostic tests BMJ 2008;336:569- 570 2 Freedman D., Furness P., Green A., Hallworth M., McCartney M., Prasad A., Thornton H., Wright C. et al Making Sense of Testing London: Sense about Science. 2008 3 Ryan A., Wilson S., Greenfield S., Clifford S., McManus R.J., Pattison H.M. Range of self-tests available to buy in the United Kingdom: an Internet survey Journal of Public Health 2006; 28: 370-374 4 Wilson S, Greenfield S, Pattison HM, Ryan A, McManus RJ, Fitzmaurice D, Marriott J, Chapman C, Clifford S. Prevalence of the use of cancer related self-tests by members of the public: a community survey. BMC Cancer 2006; 6:215 5 McManus RJ, Ryan A, Greenfield S, Pattison HM, Clifford S, Marriott J, Wilson S Self measurement of blood pressure: a community survey Journal of Hypertension 2007; 21: 741–743 6 Nandha S, Pattison H. Young people’s intentions to use self test kits for signs of coronary heart disease. Psychology and Health 2005; 20 (Suppl): 188-189 7 Stim EM. Do-it-yourself pregnancy testing. The medical perspective. Am J of Public Health. 1976;66:130-1 Competing interests: None declared