Observations

A few lessons in screening for Gordon Brown

BMJ 2008; 336 doi: https://doi.org/10.1136/bmj.39461.502581.59 (Published 17 January 2008) Cite this as: BMJ 2008;336:123
  1. Julian Tudor Hart, honorary research fellow, University of Wales Swansea Medical School, Swansea SA2 8PP
  1. julian{at}tudorhart.freeserve.co.uk

    The prime minister seems just to want to offer more consumer choice for the worried well

    Prime Minister Gordon Brown has just announced that he will allocate funding for a national screening programme concentrated on diabetes, cardiovascular and renal diseases, and stroke (BMJ 2008;336:62-3 doi:10.1136/bmj.39454.738912.4E). He said these were now seldom available except through private care but would, over the next three years, be made available to everyone.

    The politicians, civil servants, and managers who devised this plan may believe it is evidence based. I’m not so sure. So far as I know, there has been only one controlled trial of such a policy. This compared age standardised mortality over five years associated with traditional demand-led care alone in Blaengwynfi, against similar care in Glyncorrwg, where this had been integrated with proactive screening and follow-up for chronic conditions (which included those listed by the prime minister) over the previous 20 years.1 The two communities were socially almost identical. Both were in the bottom 5% of social ranking by Townsend index within the 55 local authorities then composing West Glamorgan. Apparent results were remarkable. Standardised mortality ratios for deaths at all ages were 36% above the UK mean in Blaengwynfi, 2% below it in Glyncorrwg. For deaths under age 65, the SMR was 60% above the UK mean in Blaengwynfi, 6% below it in Glyncorrwg.

    Nearly an ideal experiment?

    This was not an ideal experiment. The actual numbers of deaths under 65 were small—in Glyncorrwg, 21 deaths against 22 expected at UK rates; in Blaengwynfi, 48 deaths against 30 expected—so confidence intervals must be wide. The anticipatory care programme in Glyncorrwg evolved over 20 years, starting with blood pressure control and personal interventions on smoking, ending with a large bundle of interventions of many kinds, but all covering the entire population at risk. …

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