Letters “Informed choice” in a time of too much medicine

Citizens’ juries could help to guide screening policy

BMJ 2016; 353 doi: https://doi.org/10.1136/bmj.i3520 (Published 28 June 2016) Cite this as: BMJ 2016;353:i3520
  1. Cinzia Colombo, researcher1,
  2. Paola Mosconi, head1
  1. 1Laboratory of research on consumer involvement, Department of Public Health, IRCCS Mario Negri Institute for Pharmacological Research, Milan, Italy
  1. cinzia.colombo{at}marionegri.it

The article by Johansson and colleagues discusses informed choice in the context of the medicalisation of society, highlighting the common beliefs that “more is better” and “prevention is better than cure,” as well as the potential harm from information about a disease when people are asymptomatic, such as in screenings.1

In line with this analysis and to promote a broader role of society in public health decisions,2 citizens’ juries could be one way to guide screening policy. People would be consulted to express their opinions and to deliberate the pros and cons of screenings for the community, before individual citizens find themselves having to make a choice.1 Informed choice would be made first from a public perspective, engaging the public before implementing an intervention.

The IRCCS Mario Negri Institute’s laboratory of research on consumer involvement has organised four citizens’ juries: one on prostate specific antigen (PSA) testing as an individual screen for prostate cancer,3 and three on carrier screening for cystic fibrosis.4 As in a similar one in Australia, the jury was not in favour of PSA screening,5 a finding that falls outside the “more is better” framework. The juries on cystic fibrosis carrier screening, however, were in favour of screening, underlining the value of letting people make informed reproductive choices.

These findings were unexpected, in one sense, and they suggest that engaging the public and being informed in a balanced and transparent way could lead to different views from the mainstream.



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