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RAPID RESPONSES FROM BMJ.COM

BMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7429.E265 (Published 18 December 2003) Cite this as: BMJ 2003;327:265
  1. Daniel C Vinson, professor
  1. University of Missouri-Columbia
  2. Nijmegen University, Netherlands
  3. St Mary's Hospital, London, UK
  4. Alcohol Treatment Center Lausanne, Switzerland
  5. University of Tampere, Finlan
  6. Boston Medical Center and Boston University
  7. University of Copenhagen, Denmark

    As of November 19, 2003, this paper had generated 28 Rapid Responses, which can be read in their entirety at http://bmj.bmjjournals.com/cgi/eletters/327/7414/536. Following are edited excerpts.—Editor

    Beich and colleagues' study is an example of the prevention paradox, that few patients personally benefit from preventive interventions. Although there are fewer studies [demonstrating] that brief alcohol interventions change patients' health outcomes than [there are] in pharmacotherapy for cholesterol, screening for alcohol problems is neither more nor less caught in that paradox.

    1. Peter Anderson, independent consultant in public health
    1. University of Missouri-Columbia
    2. Nijmegen University, Netherlands
    3. St Mary's Hospital, London, UK
    4. Alcohol Treatment Center Lausanne, Switzerland
    5. University of Tampere, Finlan
    6. Boston Medical Center and Boston University
    7. University of Copenhagen, Denmark

      Two of the 8 studies that form part of the meta-analysis were mine (Scott and Anderson 1990, Anderson and Scott 1992). There are substantive errors in the numbers extracted from these studies and reported by the authors in tables 1, 2, and 3…. The authors confuse research studies with normal practice, which affects their estimates of the screening effect, thus leading to flawed conclusions…. But even without these errors, the conclusions by the authors are based on other erroneous assumptions….

      Health screening in general practice is not just about alcohol. It is about smoking, overweight, raised blood pressure, etc. So the utility of screening has to be based on broader assumptions. A general practice can target its methods …

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