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Editorials

Primary prevention of cardiovascular disease

BMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d201 (Published 25 January 2011) Cite this as: BMJ 2011;342:d201

Rapid Response:

The potential emotional and potential physical cost is not confined to screening

In his article Professsor Reckless accepts that some people find may
find screening emotionally distressing but physically harmless. The first
is undoubtedly true but in as much as it might be a 'life event' for those
who prefer to keep away from doctors the latter may not be a valid
assumption. Be that as it may, he does not consider the ongoing emotional
distress caused by the revelation of unrecognised 'disease' in the
healthy, or of adhering to regular medication,or indeed of guilt induced
by failing to do so. This has the potential for producing a negative
effect which like the placebo effect cannot be measured by conventional
clinical trials. Unlike the placebo effect which is in the desired
direction and so its contribution may be ignored, the negative effect may
exceed the specific benefit of therapy in low risk subjects. Clinical
trials would still show an apparent benefit even if screening programme
were counter-productive. Until these issues are addressed there is no
justification for universal screening. Unfortunately it is probably too
late to attempt to do the definitive study: that is to compare a screened
population with an unscreened one. The recent NHS exercise of 40-75 year-
olds missed a golden opportunity.

Competing interests: No competing interests

07 February 2011
C Kevin Connolly
Retired Physician
Richmond DL11 7UJ