The ethics of non NHS testing

I’m glad to see that this public consultation by the Nuffield Council has been launched today, asking questions about the ethical issues involved in whole-body CT scanning and genetic screening done in private clinics for people with no current health problems. It’s very good that these issues are being raised and debated. But I’m a bit concerned that some of the questions they ask of potential contributors are not quite pointed enough. I’m concerned about both evidence-based medicine and screening tests, mainly because of the potential for harm these have and the lack of balanced information the latter may come with.

By going outside the NHS, these tests certainly have potential for fragmenting care, duplicating results and creating communication problems, all things the Nuffield Council are rightly concerned about. But it isn’t really these that worry me.  It might be worthwhile risking all these things if the potential for benefit from testing could outweigh the problems. But the tests the consultation is concerned about come with no evidence to justify them. There are enormous misunderstandings about the limitations of these tests – for example, the document says that CT scans for the well “provide a person-specific disease risk profile”. I’d disagree: for a cardiovascular risk profile, a discussion, a set of weighing scales, a blood pressure and possibly a blood test or two will sort that out – and all that can be got for free on the NHS. A CT scan will not tell you an awful lot of important things. Isn’t it regulation of these “services” that is primarily needed? But these thoughts are contained in the last pages of the Nuffield’s document: I’d prefer that that was the first question in a very necessary debate.

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