News from Nowhere 90 September 2020

Computer says No!

In a recent edition of the Academic Health Economist’s Blog Chris Sampson predicted that by about 2050, all established national screening programmes will have started to change into risk-based screening programmes. This means that only those at risk will be offered screening. The pressure for this will be partly on the demand side. There will be a growing number of diseases that can be effectively treated or prevented with early intervention. But, mostly, the pressure will be on the supply side. We will have more data, more computing power, and more opportunities for automation and telehealth that will make risk-based screening too good to ignore. 

There be interesting equity concerns when it comes to risk-based screening. Sampson’s argument is that an individual’s risk of disease onset can be treated as an approximation of their need for screening. A person with a very low risk of screening positive has a very low need for screening. Given this logic those with low risk should not be offered screening, in the way that men are currently not screened for breast cancer (because there are only around 370 cases per year in men). A risk calculation engine could provide the most accurate means of differentiating risk levels.

But there are at least two ways in which a risk calculation engine might be seen to be explicitly or implicitly discriminatory and inequitable. It might discriminate explicitly if an input to the engine is (for example) ethnicity, and if people of certain ethnicities are identified as being at lower risk and therefore denied access to screening. Alternatively, such an outcome may arise indirectly, with an implicit discrimination through the correlation of biomarkers and sociodemographic characteristics.

This takes us into the realm of ‘precision medicine’, now growing vigorously in the USA. Thoughts from NfN readers on risk-based screening are welcome.


Influenza is not what it used to be

Not in Australia, anyway. Australians mostly catch influenza between May and August, but not this year. Aggregated data on laboratory-confirmed influenza cases suggests that social distancing, masks and hand hygiene may have interfered with influenza spread. The UK’s Royal College of Physicians spotted this in Australia Influenza Surveillance Report number 9 (2020). 

The Australian National Notifiable Diseases Surveillance System (NNDSS) coordinates the national surveillance of more than 50 communicable diseases or disease groups. Only laboratory positive tests are included in the influenza count. There was a steady increase in influenza notifications from weeks 1 to 11 of 2020. From week 12, notifications declined and remained low – the red line on the graph below shows influenza notifications in 2020 compared with 2015 onwards.

Sources: file:///E:/Health%20Matters/News%20from%20Nowhere/Australia%20report%202020.pdf

and Royal College of Physicians President’s report 24th August 2020

Learnt nothing…

If you missed Andy Cowper’s latest blog in the Health Service Journal then you missed this too:  “The rearranging of public health’s deckchairs is entirely predictable. “Radical reformers” with short time-horizons [such as the UK government] always prefer to focus on form rather than substance: one reason why Germany’s public services are rather better than ours. #learntnothingforgottennothing ”  Nick Macpherson, former permanent secretary to HM Treasury, 2005-2016

Source:  Cowper’s Cut ; the National Institute for Self Protection,  Health Service Journal  24/8/20

Last minute effort

How about this for a call to arms?  “… the end of PSA tests for prostate cancer and no more removal of kidney stones. Just two from a list of 31 vital health interventions which are to cease tomorrow!” Trying to mobilise opinion the day before a policy change does not suggest campaigning competence. Nor does the damnation of a report from the Expert Advisory Committee to the Evidence-Based Interventions programme on cessation of treatments and tests for 31 clinical situations. In criticising this committee the hurried defenders of the NHS – ‘Calderdale and Kirklees 999 Call for the NHS’ – get almost everything wrong. To take their initial statement, Prostate Specific Antigen testing in asymptomatic men is not recommended, whereas men with enlarged prostates who considering surgical intervention should be counselled thoroughly regarding alternatives to and outcomes from surgery. Sound advice in both situations, with similar scientifically-justified recommendations in 29 other scenarios and not a ‘cut’ in sight.


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