Wednesday, 22 October 2008

GPs sailing close to the wind

The screening for certain disease has had massive impacts upon our health, for example cervical cancer, however screening is only appropriate should certain criteria be satisfied. A number of factors should be considered before screening for a particular disease, they are nicely summarised by the WHO here. For an example of a cancer that it is pointless, arguably dangerous, to routinely screen people for, then take Ovarian cancer.

Firstly the blood test for the tumour market Ca-125 is a waste of time, it is not particularly sensitive and very non specific. Secondly screening with ultrasound scans is also dangerous, as for every cancer detected several women will undergo pointless diagnostic surgery which has obvious risks attached (estimates of this number are 2.5 to 60 women needing surgery for every cancer detected). There is also no decent evidence that early detection of the cancer will reduce mortality. Interestingly even in the high risk groups there is no evidence that screening is of benefit in terms of median survival and overall mortality:

"Although there is interest in identifying and screening these very high-risk women, there is no evidence that screening benefits this group in terms of median survival or overall mortality."

So overall screening for ovarian cancer appears foolish at best, unethical and reckless at worst. So when I hear that some GP practices are sending letters to their older female patients to advertise the screening for ovarian cancer by a certain private health firm (Health Screen Clinic or Health Screen First Limited as they are technically known) I get a little hot under the collar. This is unethical at best and given that they are sending out the private health firm's propaganda with their letter, it is sailing very close to the wind indeed. This has already recieved coverage in the national press, so why are some GPs still pestering their patients with this private firm's propaganda against the advice of the BMA?

In fact the private health firm recommend screening for people with only one first degree relative who has been affected, they are also using the rather useless Ca-125 blood test which costs the patient are rather significant amount of money. I see this behaviour from the private health firm as scaremongering, they are trying to scare a vulnerable group of patients into spending their money on screening themselves for a disease, that even if detected may not result in any improved survival. The GPs are complicit in this. In the GMC's duties of a doctor it states in the probity section:

-you must not put pressure on patients to accept private treatment
-you must not exploit patients' vulnerability or lack of medical knowledge when making charges for treatment or services

These GPs would struggle to defend their position in front of the GMC. Not only do they stand to gain financially by leasing their rooms to this private firm, but also they are distributing this firm's factually inaccurate propaganda to their patients. I am not sure if this is an isolated example, it may well be going on in many other areas, and I would be very keen to know if this is the case. Interestingly the BMA's advice makes it clear that GPs know that they should be steering well clear of this particular firm, the wind is indeed close, maybe too close for comfort:

"The GPC has asked LMCs to warn all practices in their area of the significant risks they take should they involve themselves with this company and its current business model.

  1. The practices could be deemed in breach of their GMS or PMS contract for breaking regulation 24 in relation to fees and charges, as they are receiving an indirect fee for their involvement in letting this private company screen their patients. The level of involvement in the company’s operations and the payment of a fee for rent, means that this goes beyond any allowance to rent practice space to an individual practitioner or company as permitted in the Premises Directions.
  1. The practices are in breach of the Data Protection Act. They hold patient data as part of their NHS contract. It was never intended, and patients are not aware or indeed have consented to their personal data being utilised for the purpose of advertising private services.
  1. The practices could be deemed to be in breach of the GMC’s Good Medical Practice (probity guidance) and therefore may be open to ‘fitness to practice’ procedures."

1 comment:

Jobbing Doctor said...

Good points, well made. I wouldn't touch these quacks with a bargepole.

I actually teach 2nd Year Medical Stiudents the basis of screening (Wilson's and Cadman's criteria) and it is disappointing that qualified GPs can't even use an iota of scientific training to see through this guff.